INTRODUCTION

INTRODUCTION

INTRODUCTION:

Occlusal Vertical Dimension (OVD) is a fundamental component of dental occlusion

and prosthodontic treatment. It refers to the vertical height between two selected points when

the upper and lower teeth are in contact. The determination of OVD is crucial in the

fabrication of complete dentures, full-mouth rehabilitations, and occlusal restorations, as it

directly influences masticatory function, speech, facial esthetics, and temporomandibular

joint (TMJ) health.[1][2]

A precise OVD measurement ensures that prosthetic restorations function

harmoniously with the surrounding musculature and temporomandibular structures. However,

errors in OVD determination can result in several functional and esthetic problems. An

increase in OVD may lead to excessive tooth contacts, causing discomfort, speech

impairment, muscle fatigue, and temporomandibular dysfunction[1],[3].Additionally, it can

create an unesthetic appearance characterized by excessive fullness of the lips and perioral

tissues. Conversely, a reduction in OVD can result in a collapsed facial profile, diminished

biting efficiency, and increased strain on the TMJ[4]. Patients with reduced OVD often present

with deep nasolabial folds, a sunken lower third of the face, and a compromised ability to

chew efficiently.[5]

Given these potential complications, determining the correct OVD is essential for

achieving optimal patient outcomes. The accurate determination of OVD is a complex and

multifactorial process. However, unlike other dental parameters such as tooth size and arch

dimensions, due to the lack of a direct anatomical landmark for measuring OVD, its

determination remains one of the most challenging aspects of prosthodontic

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 INTRODUCTION

[Link], several methods have been proposed to estimate OVD, each with

its advantages and limitations.[6]

One of the most reliable methods for determining OVD is the use of pre-extraction

records, which include radiographs, study casts, and photographic documentation taken

before tooth loss. These records provide an accurate reference for reconstructing the patient’s

original vertical dimension. However, such records are often unavailable for many patients,

particularly those who have been edentulous for an extended period.[7]

In cases when pre-extraction records are not accessible, clinicians rely on alternative

methods, including phonetic tests, esthetic evaluations, cephalometric analysis, and

functional assessments.[8] The phonetic method, which involves evaluating speech sounds

such as “s” and “m,” is commonly used but is subjective and may not always yield consistent

results.[6] The swallowing method, another widely used technique, depends on the patient’s

neuromuscular control, which can vary significantly among individuals.[9][10]

Cephalometric analysis, which involves radiographic assessment of craniofacial

structures, provides a more objective approach. However, it requires specialized equipment,

trained personnel, and additional radiation exposure, making it less practical for routine

clinical use. Similarly, the use of facial measurements, such as the distance between the nose

and the chin, has been explored, but variability in soft tissue thickness and facial proportions

can affect the reliability of this method.[11]

Given the inherent limitations of traditional methods, researchers have sought

alternative approaches that are simple, non-invasive, and reproducible. One such approach is

the use of anthropometric measurements to establish a correlation between OVD and other

stable anatomical structures. [12]

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 INTRODUCTION

Anthropometry, the scientific study of human body measurements, offers a promising

solution for determining OVD. Anthropometric studies focus on the correlation between

craniofacial dimensions and other stable anatomical landmarks, allowing clinicians to

estimate OVD with greater accuracy. This method is particularly valuable in cases where

conventional techniques are impractical or unavailable.[12]

One of the key anthropometric parameters studied in relation to OVD is thumb length.

The thumb, being a well-developed and evolutionarily stable structure, has been hypothesized

to maintain a proportional relationship with facial dimensions, including the lower facial

height. Studies have suggested that measuring thumb length could provide an objective

reference for determining OVD, offering a practical and reproducible method for [Link]

addition to thumb length, other hand and facial measurements have been explored. The

distance from the tip of the thumb to the tip of the index finger, the length from the rima oris

(corner of the mouth) to the center of the pupil, and the distance from the outer canthus of the

eye to the tragus of the ear have all been investigated as potential predictors of OVD. These

measurements are easy to obtain using digital calipers and do not require complex

instrumentation or invasive procedures.[13-48]

Recent studies have shown promising correlations between these anthropometric

measurements and OVD, suggesting their potential application in clinical dentistry. However,

variations in facial proportions, ethnic differences, and individual anatomical variability must

be considered when applying these methods. While some studies report strong correlations

between thumb length and OVD, others suggest that gender and age-related differences may

influence these measurements. Therefore, further research is needed to validate these findings

across diverse populations.

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 INTRODUCTION

Despite the advancements in prosthodontic techniques, the determination of OVD

remains a subject of debate and ongoing research. Existing methods, while useful, often have

limitations that hinder their widespread clinical applicability. The use of anthropometric

measurements presents a novel and potentially more reliable approach, but further

investigation is required to establish its accuracy and consistency.

The present study aims to evaluate the correlation between OVD and various

anthropometric measurements in dentulous male and female subjects. By identifying reliable

anatomical landmarks that correlate with OVD, this research seeks to develop a practical and

evidence-based method for determining vertical dimension. The findings of this study may

have significant implications for prosthodontic treatment planning, particularly in cases

where traditional methods are inconclusive or unavailable.

Furthermore, this study will contribute to the growing body of research in dental

anthropology, providing insights into the relationship between craniofacial dimensions and

overall body proportions. By analyzing gender-based differences in OVD estimation, this

study also aims to explore whether certain anthropometric markers are more applicable to

specific populations.

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AIM AND OBJECTIVES
 AIMS AND OBJECTIVES

AIM
To evaluate the correlation between the occlusal vertical dimension and various

anthropometric measurements in dentulous male and female subjects.

OBJECTIVES
1) To find out the correlation between the length of thumb and occlusal vertical dimension

measured from tip of nose and most prominent point on chin in dentulous subjects for both

males and females.

2)To find out the correlation between the tip of thumb to tip of index finger length and

occlusal vertical dimension in dentulous subjects for both males and females.

3)To find out the correlation between the occlusal vertical dimension and length measured

from rima oris (corner of mouth) to centre of pupil of eye in dentulous subjects for both

males and females.

4) To find out the correlation between the occlusal vertical dimension and length measured

from lateral border of the outer canthus (eye) to the tragus of the ear in dentulous subjects for

both males and females.

5) To compare means of various anthropometric measurements in both male and female

subjects.

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Numerous studies have investigated these correlations using diverse methodologies,

contributing to a comprehensive understanding of their role in OVD determination across

different populations

George Franklin McGee (1947)[13] conducted a study to establish a method for determining

vertical dimension of occlusion (VDO) in edentulous patients using facial measurements. His

study included 52 individuals and recorded multiple facial landmarks such as pupil to

stomion (distance from the center of the eye to the upper lip), glabella to subnasion (forehead

to the area below the nose), cheilion to cheilion (corner of mouth to corner of mouth), and

subnasion to gnathion (distance from the base of the nose to the lower chin). These

measurements were correlated with anterior tooth relationships, including overjet, overbite,

and edge-to-edge occlusion. McGee concluded that these parameters provided a reliable

estimation of VDO in complete denture construction. Additionally, this technique allowed

dentists to visualize and describe the expected esthetic outcome to patients before treatment,

enhancing psychological acceptance.

Meyer M. Silverman (1953)[14] introduced the Closest Speaking Space (CSS) method to

determine VDO, emphasizing phonetics. His approach involved asking the patient to close in

centric occlusion and marking a reference line on a lower anterior tooth at the horizontal level

of the opposing upper incisal edge. The patient was then instructed to say “yes” and

pronounce the /s/ sound, after which a second reference line was marked at the upper incisal

edge level on the same lower anterior tooth. The distance between the two reference lines,

known as the closest speaking space, provided a reliable and reproducible assessment of the

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patient’s original VDO before the loss of natural teeth. Silverman recommended recording

this space after the age of 20 for future use in prosthetic rehabilitation.

Lewis C. Turner (1969)[15] developed a novel approach using profile tracers and diagnostic

casts before tooth extraction to assist in prosthetic reconstruction. His methodology included

taking pre-extraction impressions of both maxillary and mandibular arches using alginate and

preserving them as diagnostic casts. Profile templates were then created based on these casts

to guide the fabrication of occlusion rims. Turner emphasized that these templates ensured

accurate lip support and occlusal height in complete dentures. He concluded that pre-

extraction records significantly enhanced the precision of prosthetic rehabilitation, allowing

for a more natural facial appearance and improved functionality.

Leonard S. Fishman (1982)[16] introduced a method for evaluating skeletal maturation using

hand-wrist radiographs. His study aimed to establish a progressive scale of skeletal

maturation indicators (SMIs) that could be used in dentofacial orthopedic diagnosis and

therapy. Additionally, he aimed to determine the growth and development status of an

individual using hand-wrist X-rays, which could be correlated with mandibular and maxillary

growth. Although this study focused primarily on orthodontics, it had implications for

prosthodontics, as skeletal maturity influences jaw positioning, occlusion, and VDO

adjustments in growing patients.

Farhad Fayz and Ahmad Eslami (1987)[17] examined anatomical variations in VDO

determination among 25 individuals (17 males, 8 females) aged 30-60 years with complete

anterior dentition and stable posterior occlusion. They observed significant individual

variations in tooth morphology, crown height, and interocclusal distance. Despite these

anatomical differences, the study provided guidelines for the initial placement of anterior

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teeth and estimation of VDO, reinforcing the concept that natural dentition follows distinct

anatomical patterns.

G. A. V. M. Geerts, M. E. Stuhlinger, D.G. Nel. (2004)[18] conducted a study comparing two

commonly used VDO measurement techniques: the Willis Gauge Method and the Caliper

Method. Involving 20 predoctoral students, their research found that the caliper method,

which measured the distance between the tip of the nose and the chin, was more consistent

and reliable across multiple trials. In contrast, the Willis gauge method, which measured the

distance between the septum of the nose and the chin, showed greater variance, making it less

precise for VDO measurement. The study concluded that calipers should be the preferred tool

for VDO assessment in edentulous patients.

Bissau M. (2004)[19] reviewed various pre-extraction records (PERs) used to establish VDO

and arrange maxillary anterior teeth. His review covered diagnostic casts, Willis gauge,

profile templates, orofacial devices, radiographs, photographs, closest speaking space, and

physiological rest position measurements. He confirmed that PERs provided the most

accurate VDO estimation and were preferable over arbitrary methods in prosthetic

reconstruction.

Chris Jackson (2008)[20] carried out a study with 360 participants (267 females, 93 males), of

whom 9% were left-handed and 81% were right-handed. The sample comprised 72%

individuals of White origin and 18% of Chinese and Southeast Asian origin, with a mean age

of 19.20 years (SD = 1.57). Hand asymmetry was assessed using two measures: Hand Use

and Hand Preference. Hand Use was determined through self-reported handedness, with

right-handers scored as 1 and left-handers as 0, and data were provided by 265 participants.

Hand Preference was evaluated using the Hand, Ear, and Eye Preference (HEEP)

Questionnaire, a modified version of the lateral preference questionnaire. The study

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demonstrated high internal consistency across all scales, indicating reliable measurements.

Strong correlations were found between the second and fourth digit (2D and 4D) lengths of

the left and right hands, as well as between Hand Use and Hand Preference.

Narayan Kulkarni and Monika Kohli (2011)[21] conducted a study on 1000 male and

female students, with an equal sex distribution, aged between 22 and 24 years, who were

enrolled in medical and dental programs. The study found that males exhibited greater total

body height, total face height, upper face height, middle face height, and lower face height

compared to females. Additionally, the facial proportions of the participants did not align

with the standard acceptable proportions. Notable deviations were observed in both males

and females concerning lower face height in comparison to upper face height. Given these

variations, lower face height was identified as a more reliable indicator of total body height

and total face height.

R. Ladda, A. J Bhandari, V. O Kasat, G. S Angadi(2013)[22] performed a cross-sectional

study on 400 dentate subjects (200 males, 200 females) to investigate the correlation between

finger length and VDO. They found that in males, VDO correlated strongest with index

finger length, while in females, it correlated strongest with little finger length. The study

concluded that finger length could be a reliable, simple, and non-invasive predictor of VDO.

Nagpal A, Parkash H, Bhargava A, Chittaranjan B (2014)[23] conducted a study to

evaluate the reliability of various facial measurements for determining the vertical dimension

of occlusion (VDO) in edentulous patients, using facial dimensions recorded from dentulous

individuals. The study involved 180 subjects, including 75 dentate males, 75 dentate females,

and 30 edentulous subjects (15 males and 15 females), aged 50–60 years. Key measurements

were taken, including the VDO and the vertical dimension of rest. The study found that the

left outer canthus of the eye to the angle of the mouth distance and the right ear-eye distance

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were valuable adjuncts for determining VDO. However, measurements such as the Glabella-

Subnasion distance, Pupil-Stomion distance, Pupil-Rima Oris distance, and the distance

between the two angles of the mouth did not significantly contribute to determining the VDO.

The study concluded that alternative facial measurements could be used with reasonable

accuracy to determine VDO in edentulous patients, especially when no pre-extraction records

are available.

Basnet BB, Parajuli PK, Singh RK, Suwal P, Shrestha P, Baral D’s (2015)[24] study on

500 adult dentulous volunteers to measure occlusal vertical dimension (OVD), thumb length,

eye–ear distance, and the distance between the pupil of the eye and the rima oris. The

relationship between OVD and thumb length, along with other anatomical measurements,

was analyzed using Pearson’s product-moment correlation coefficient. Additionally, linear

regression analysis was performed to assess the association between OVD and thumb length.

The findings indicated a significant correlation between thumb length and OVD across both

ethnic groups. Based on these results, the authors concluded that, within the limitations of the

study, thumb length could serve as an adjunctive measure for determining OVD in edentulous

patients.

Alhajj MN, Khalifa N, Amran A (2016)[25] examined 114 dental students (76 males and 38

females) with a mean age of 22.34 ± 1.83 years. The study compared the distance from the

distal canthus of the eye to the rima oris (eye-RO) with two different measurements of

occlusal vertical dimension (OVD): nasal (N) to gnathion (Gn) and subnasal (Sn) to menton

(Me). All measurements were obtained using a modified digital caliper. The authors

concluded that the distance from the outer canthus of the eye to the parting of the lips appears

to be a reliable predictor of OVD and should correspond to the distance from the tip of the

nose to the tip of the chin.

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Ahmed M and Helal M. (2016)[26] conducted a cross-sectional study on 132 male subjects,

divided into two groups: Group 1 (G1) consisted of 120 dentate individuals, while Group 2

(G2) included 12 completely edentulous individuals. Various facial and anatomical

measurements were taken using a modified caliper, including base of chin–subnasale (FM1),

base of chin–tip of the nose (FM2), Willis’ measurement (FM3), glabella–subnasale (FM4),

length of the index finger (AM1), and tip of thumb–tip of index finger (AM2). For G1,

measurements were taken while subjects were in centric occlusion, whereas for G2, they

were recorded while maxillary and mandibular complete dentures were in centric relation.

Statistical analysis was performed using the paired t-test, Pearson’s correlation, and

regression analysis. The authors concluded that a linear equation predicting the base of chin–

subnasale measurement using Willis’ measurement is recommended and can serve as a useful

guide for restoring the vertical dimension of occlusion.

Shah DS, Duseja KV, Shah MU (2017) [27] carried out a clinical study in India on 100

dentulous subjects to explore the association between VDO and facial measurements.

Anthropometric measurements, including interpupillary distance and ear length, were

recorded using a digital Vernier caliper. Using Pearson’s correlation analysis (at a

significance level of ≤0.05 and 95% confidence interval), the relationship between these

facial landmarks and VDO was evaluated through SPSS version 22.0, and prediction

equations were developed. Results indicated a significant positive correlation between VDO

and all studied parameters, with the strongest correlation found for interpupillary distance in

males (r = 0.570) and the weakest for ear length in females (r = 0.319). The study concluded

that facial measurements can serve as a reliable adjunct to conventional methods for

estimating VDO, particularly aiding the clinical assessment in completely edentulous

patients.

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Akhma NE, Sumarsongko T, Rikmasari R. (2017)[28] performed an analytical cross-

sectional study to compare the OVD and pupil-rima oris distance in the Sundanese

population. The study involved fifty Sundanese students from the Faculty of Dentistry,

Universitas Padjadjaran, who met the inclusion criteria. The researchers measured both the

OVD and the pupil-rima oris distance to determine any significant differences. The results

revealed no significant difference between the OVD and pupil-rima oris distance (α = 5%),

but there were strong correlations between the two parameters (p < 0.05). Spearman's rank

correlation test showed a significant difference in the OVD and pupil-rima oris distance

between males and females. Based on these findings, the study concluded that while no

significant difference was found, the pupil-rima oris distance can be considered a reliable

objective method for determining OVD length in the Sundanese population.

Khanehzad M, Madadi S, Tahmasebi F, Kazemzadeh S, Hassanzadeh G. (2018) [29]

implemented an anthropometric study in Iran on 200 dentate subjects, both males and

females, with a mean age of 24.91±5.85 years, to evaluate the correlation between occlusal

vertical dimension (OVD), thumb length, and certain facial landmarks. Measurements of

OVD, thumb length (TL), the distance from the rima oris to the pupil (RO-Pu), and the

distance from the nasal alar to the tragus of the ear (N-E) were recorded and analyzed.

Results showed statistically significant positive correlations between OVD and all studied

parameters across the total sample, with a particularly strong correlation between OVD and

RO-Pu distance in both genders. The study concluded that the RO-Pu distance could serve as

a more reliable method for predicting OVD compared to other facial landmarks

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Kamila Sihuay-Torres and Yuri Castro-Rodríguez (2019)[30] undertook a cross-sectional,

observational study in Peru involving 114 dental students with Class I malocclusion and

complete dentition to investigate the relationship between anthropometric finger lengths and

vertical occlusal dimension (VOD). VOD was measured clinically from the subnasal point to

the mental point, while anthropometric measurements included finger lengths and the

projected distance between the thumb and index finger. Statistical analysis revealed a

significant positive correlation between VOD and the lengths of the index finger (r = 0.29,

p<0.01), middle finger (r = 0.31, p<0.01), and little finger (r = 0.23, p<0.05). No significant

correlation was observed with the ring finger or thumb lengths. The study concluded that

certain finger measurements, particularly of the index, middle, and little fingers, can assist in

estimating VOD, providing a simple anthropometric method to support clinical assessment.

S. Tripathi, M. Pandey, S. Agarwal, S. Gupta, A. Sharma (2019)[31] studied 500 dentate

subjects to explore the relationship between hand anthropometric measurements and VDO

estimation. The study measured thumb length, index finger length, little finger length, and the

tip-of-thumb-to-tip-of-index-finger distance. Findings indicated that in males, thumb length

had the strongest correlation with VDO, whereas in females, the tip-of-thumb-to-tip-of-index-

finger distance was the best predictor.

Saxena D, Bhayana R, and Aggarwal S (2019)[32] undertook a cross-sectional study in India

on 200 medically fit dentate subjects (100 males and 100 females) from the Uttar

Pradesh,India. West region to investigate the correlation between vertical dimension of

occlusion (VDO) and finger length. Anthropometric measurements of VDO, little finger

length, and the distance between the tips of the thumb and index finger on the right hand were

recorded clinically using a digital Vernier caliper. Spearman’s coefficient was employed to

study correlations, and regression analysis was executed using IBM SPSS software version

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24.0. Results showed that the length of the index finger could assist in estimating VDO in

females, while the little finger length was more reliable for males. The study concluded that

this method is reliable, reproducible, simple, economical, and non-invasive for clinical VDO

assessment.

Sambath K, Neethu L, Vinni T K, Gilsa K Vasunni, Shifa Balkhis A, and Pramod

Kumar A V (2019)[33] performed a study on 300 physically healthy dentate subjects aged 30-

45 years from the Malabar region of Kerala to investigate the correlation between the vertical

dimension of occlusion (VDO) and the lengths of the index and little fingers. VDO and finger

lengths were measured using a modified Vernier caliper, and data were analyzed using

descriptive statistics, Pearson’s correlation, and regression analysis. Results showed a

significant positive correlation between VDO and both the index finger (r = 0.682) and little

finger (r = 0.514), with a stronger correlation to the index finger length. The standard error

for VDO estimation was ±4.05 in males and ±3.62 in females for index finger length, and

±4.79 in males and ±3.75 in females for little finger length. The study concluded that the

length of the index finger, within a range of 3-4 mm, could be a reliable predictor of VDO.

Rahmi E, Hidayati H, Suprianto K, Chairani CN, Rahmadita S, Ladiovina M. (2020) [34]

conducted a cross-sectional study involving 336 dentate subjects (168 males and 168 females,

aged 20-35 years) from various Indonesian subraces, including Deutro-Malay, Proto-Malay,

and Indonesian Chinese, to analyze the correlation between occlusal vertical dimension

(OVD) and the length of the little finger (LLF). Anthropometric measurements of OVD and

LLF were recorded clinically using a digital Vernier caliper. Pearson’s correlation was used

to analyze the data, revealing a significant positive correlation (p = 0.000) between OVD and

LLF, with a strong correlation coefficient of r = 0.779. The study concluded that there is a

significant correlation between OVD and LLF measurements in Indonesian subraces.

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Preetha Krishnamurthy, Yogitha K, N Shanmuganathan, Kapil R (2021)[35] examined 80

dentate individuals (20-25 years old) to investigate the relationship between ear length, finger

length, and VDO. The study found a positive correlation between ear length, index and little

finger lengths, and VDO, suggesting these anatomical features as useful predictors of

occlusal height.

Basutkar N, Borham AM, AlGhamdi SA, Alderea EW, AlShammari MM, and Sheikh

KH (2021) [36] conducted a cross-sectional study in Saudi Arabia on 500 subjects to evaluate

the reliability of anthropometric measurements for establishing vertical dimension of

occlusion (VDO). Using digital Vernier calipers, measurements such as the index, little, and

thumb finger lengths, and distances between specific facial landmarks, were recorded. The

intervention involved statistically analyzing these measurements to correlate them with VDO.

Results showed a strong positive correlation, with the index finger length most strongly

correlated with VDO in males (r = 0.7341) and the little finger length in females (r = 0.5827).

The authors concluded that in Saudi males, VDO could be reliably approximated using the

index finger, while in Saudi females, the little finger and the outer canthus to mouth distance

were more predictive. They emphasized the importance of using multiple methods to cross-

verify VDO measurements in clinical practice.

Ayusha Bajracharya, Kanchana Shrestha, Shyam Maharjan, and Suraj RB Mathema

(2021)[37] performed a study on 115 dental students from Kathmandu Valley, Nepal, to

compare and correlate the vertical dimension of occlusion (VDO) with the length of fingers

across different genders and ethnicities. The study included 41 males and 74 females, with 59

Aryan and 56 Mongolian participants. VDO was measured from the base of the nose to the

base of the chin, while finger length was measured using a modified digital Vernier caliper.

Statistical analysis revealed a positive correlation between VDO and the lengths of all fingers

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on both hands, with p values < 0.05. The mean VDO of males was 4.28 mm higher than that

of females, and the mean VDO among Aryans was 2.43 mm lower than that of Mongolians.

The highest correlation between VDO and finger length was observed with the thumb in both

Aryans and Mongolians, with statistically significant results (p < 0.05). The study concluded

that VDO is positively correlated with finger length, gender, and ethnicity, with a

proportional relationship existing between VDO and the thumb length, regardless of gender

or ethnicity.

Vare SS, Babu MS, Dev RR, Asritha S (2021)[38] conducted a study to determine the

correlation between the OVD and thumb length in the coastal Andhra population. The study

involved 220 subjects, and OVD was measured using the Niswanger and Thomson method,

where pinpoint markings were placed on tattoo stickers at the tip of the nose and the most

prominent point on the chin. Thumb length was measured with a Vernier caliper, from the

proximal point at the radial side of the first metacarpophalangeal joint to the distal point

(dactylion). The sample size was determined using G power analysis with Zα 0.05, Power

80%, and effect size 0.6. Pearson’s correlation test revealed a significant positive correlation

(p = 0.001) between thumb length and OVD, with a Pearson coefficient of 0.662 in the whole

population. Regression analysis confirmed that thumb length is significantly related to OVD.

The study concluded that, despite its limitations, thumb length can be used as an alternative

method to establish OVD, especially in edentulous patients.

Tope Emmanuel Adeyemi et al. (2022)[39] conducted a cross-sectional prospective

observational study at the Dental Clinic of Aminu Kano Teaching Hospital to evaluate facial

height measurements in predicting occlusal vertical dimension (OVD). The study included

103 individuals (69 males, 34 females) aged 18–58 years and used digital calipers to record

upper facial height (UFH), midfacial height (MFH), and lower facial height (LFH). Statistical

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analysis revealed that midfacial height (MFH) had the strongest correlation with lower facial

height (LFH), leading to the derivation of a best-fit model equation for LFH estimation. The

study concluded that MFH is a predictable factor for LFH estimation, which can be used for

OVD determination in clinical settings.

Pooja Kumari, Sajida Khuhawar, Muhammad Rizwan Memon, Madiha Khalid

Memon, Naresh Kumar, and Priya Rani Harjani(2022)[40] conducted a cross-sectional

study to determine the mean OVD in a dentate population using various anthropometric

measurements related to the eye. The study, conducted at Liaquat University of Medical and

Health Sciences, included 100 patients with complete dentition, with a mean age of 22.75

years. The eye characteristics measured included the distance between the outer canthus of

one eye and the inner canthus of the opposite eye, outer canthus to rima oris, interpupillary

distance, mid pupil to rima oris distance, and canthus to tragus distance. The results showed

that the mean OVD was 67.73 mm, with various eye measurements such as intercanthus

distance (63.13 mm), interpupillary distance (61.21 mm), and rima oris to pupil distance

(67.46 mm). The study concluded that the OVD index, based on these eye measurements,

could serve as a useful tool in clinical settings for estimating the vertical dimension of

occlusion, providing a practical reference before employing other methods.

VS Bhat,S Shetty and S Khizer. (2023)[41] conducted a clinical study to investigate the

correlation between intercondylar distance (ICD) and occlusal vertical dimension (OVD) in

258 dentate individuals aged 18 to 30 years. The study found a strong positive correlation

between ICD and OVD, with a statistically significant relationship (R = 0.619, P < .001). The

research concluded that ICD could be used as an objective and non-invasive predictor of

OVD in edentulous patients, providing an alternative to conventional clinical judgment-based

approaches.

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Hana E. Mahjoub et al. (2023)[42] explored the relationship between facial and finger

anthropometric measurements in VDO estimation. Conducted on 117 individuals with Class I

occlusion, the study found that in Libyan females, index and little finger lengths correlated

significantly with VDO. Additionally, in both sexes, the inner canthus-to-Rima Oris

measurement was a reliable predictor of VDO, providing a simple and objective approach for

prosthetic rehabilitation.

Manjeev Guragain et al. (2023)[43] conducted a cross-sectional study at Tribhuvan

University Teaching Hospital, Nepal, assessing finger length as a predictor of OVD in 145

MBBS and BDS students. The study found a moderate positive correlation between OVD and

all four fingers in males, while in females, only the index finger showed a significant

correlation. This research demonstrated that finger length could serve as a non-invasive

method for prosthetic rehabilitation.

Kamboj E, Garg S, Kalra N(2023)[44] performed a cross-sectional study at a Dental College

in Ambala district, Haryana, India, from February 2021 to July 2023. The study aimed to

evaluate the correlation of various facial measurements with the vertical dimension of

occlusion (VDO) in dentate subjects. A total of 100 subjects (50 females and 50 males) aged

20-35 years were included in the study. Five facial parameters were selected for correlation

with the VDO: the distance from glabella to subnasion, the distance from the outer canthus of

one eye to the inner canthus of the other eye, the distance from the outer canthus to the rima

oris, the distance from the outer canthus to the external auditory meatus (EAM) on the left

side of the face, and the interpupillary distance (IPD). These measurements were taken using

a digital vernier caliper and a PD ruler, with each measurement recorded three times by a

single [Link] study found that the mean VDO for males was 59.29±6.48 mm, and for

females, it was 52.34±5.92 mm. The results revealed a significant positive correlation (p <

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 REVIEW OF LITERATURE

0.05) between the VDO and facial measurements such as glabella to subnasion, outer canthus

to inner canthus, outer canthus to rima oris, and outer canthus to EAM for both males and

females. However, no significant correlation was found between the VDO and IPD for both

genders (p-value for males: 0.296, p-value for females: 0.66).The study suggests that facial

measurements could be useful in determining the vertical dimension of occlusion in

completely edentulous patients when combined with other reliable methods.

Mehmet Berk Kaffaf and Olcay Şakar (2024) [45] carried out a clinical study on 271

participants to identify facial and hand measurements strongly correlated with OVD. Their

findings revealed strong correlations between OVD and various facial distances, such as

pupil-to-cheilion, sellion-to-stomion, and stomion-to-pogonion. Additionally, hand

measurements, such as four-finger width (index to little finger), were found to be reliable

predictors of OVD.

Abdel Naser M. Emam (2024)[46] studied dentulous and edentulous Saudi patients to assess

the reliability of facial measurements in predicting OVD. His findings indicated that in

edentulous patients, the pupil-to-mouth corner distance strongly correlated with OVD, while

in dentate subjects, the outer-to-inner canthus distance was the best predictor. The study

confirmed that facial measurements could provide accurate OVD estimations, aiding in full-

mouth rehabilitation.

Bacali C, Constantiniuc M, Craciun A, and Popa D(2024)[47] executed a study involving

236 Romanian and French dental students to explore the correlation between vertical

dimension of occlusion (VDO), finger length, and palm width. VDO was assessed using the

Willis Bite Gauge, while the left hands of participants were scanned with a flat-bed scanner

to measure palm width and finger lengths. Statistical analysis through one-way ANOVA and

Student’s t-test revealed that French subjects exhibited higher average VDO values than

19
 REVIEW OF LITERATURE

Romanian students, and across both nationalities, women showed higher VDO values

compared to men. Significant correlations were found between VDO and the analyzed hand

measurements, with the strongest correlation observed between VDO and palm width at the

finger base, followed by middle finger length. The study concluded that simple formulas

based on palm width and finger length could be effectively used for rapid VDO

determination.

Bhadel R et al.(2024)[48] conducted a study to explore the relationship between various facial

measurements and the vertical dimension of occlusion (VDO) in dentate individuals, aiming

to provide a reliable adjunct for VDO determination, particularly for edentulous patients. The

study included 120 subjects (60 males and 60 females, aged 19-30). The VDO was measured

as the chin-nose distance, while other facial parameters such as the glabella to subnasion,

pupil to rima oris, mouth-corner to outer canthus, and ear to eye distances were also recorded.

The findings revealed a strong positive correlation between the chin-nose distance and the

mouth-corner to outer canthus, ear to eye, and pupil to rima oris distances, with correlation

coefficients ranging from 0.660 to 0.739. These results suggest that these facial

measurements can serve as useful, non-invasive adjuncts for determining VDO, aiding in

accurate full-mouth rehabilitation and prosthodontic procedures for edentulous patients.

Anthropometric approaches provide valuable, non-invasive methods for VDO

estimation, especially in edentulous patients. Facial landmarks, phonetic techniques, and hand

measurements have been found to correlate significantly with VDO, enhancing accuracy in

prosthetic rehabilitation. The integration of pre-extraction records, digital calipers, and

radiographic analysis further improves precision, making these methods practical for

everyday clinical use.[50][51] Future research should explore digital technologies and AI-based

facial scanning to refine these techniques further.

20
MATERIALS AND

METHODS
 MATERIAL AND METHODS

MATERIALS AND METHODS

1. MATERIALS

1.1 Study Design

This study was designed as an observational cross-sectional study conducted in the

Department of Prosthodontics and Crown & Bridge at a dental institution. Ethical approval
was obtained from the Institutional Ethics Committee (IEC) before initiating the study.

1.2 Sample Size and Sampling Technique

The sample size was determined based on previous studies that evaluated the correlation
between occlusal vertical dimension (OVD) and anthropometric measurements. The
following formula was used for sample size calculation:

Calculation

Sample size was determined using the estimated values from the parent article using the
formula [24]
Total sample size = N = [(Zα+Zβ)/C]2 + 3
where Zα is the z variate of alpha error i.e. where Zα is the z variate of alpha error i.e. a
constant with value 1.96, Zβ is the z variate of beta error i.e. a constant with value 0.84
[49]
C = 0.5 * ln[(1+r)/(1-r)]

Based on this calculation, a minimum sample of 82 subjects was required. To account for
potential attrition, the study recruited a total of 200 dentulous subjects (100 males and 100
females) using a convenience sampling technique.

1.3 Consent and Ethical Considerations

1. Written informed consent was obtained from all participants before data collection.
(Annexure 1)
2. Subjects were informed about the nature of the study, the procedures involved, and
their right to withdraw at any stage without consequences.
3. The confidentiality of participants’ data was maintained throughout the study.

21
 MATERIAL AND METHODS

1.4 Instruments and Equipment Used(Color Plates)

Instruments:

1. Mouth mirror
2. Periodontal probe
3. Tweezers
4. Equipment:
5. Digital Vernier Caliper (±0.01 mm accuracy) – Used for precise anthropometric
measurements.

Miscellaneous Materials:

1. Metallic ruler – For marking measurement points.

2. Marker pens – For identifying anatomical landmarks.
3. Data recording sheets – For systematically documenting measurements.

2. METHODOLOGY

2.1 Selection Criteria

2.1.1 Inclusion Criteria

1. Subjects with a complete natural dentition (third molars not considered).

2. Dentulous individuals with intact upper and lower teeth without prosthetic
restorations.
3. Individuals aged 18 to 40 years, to minimize age-related variations in facial
measurements.
4. Subjects with a straight facial profile upon visual examination.

2.1.2 Exclusion Criteria

 History of prosthodontic, orthodontic, or maxillofacial surgery affecting OVD.

 Presence of large carious lesions, missing teeth, or temporomandibular joint (TMJ)
disorders.
 Subjects with hand or facial abnormalities (e.g., congenital defects, trauma, or
surgical alterations).
 Individuals with systemic conditions affecting craniofacial structures (e.g.,
acromegaly, muscular dystrophy).

22
 MATERIAL AND METHODS

2.2 Measurement Protocol

Anthropometric measurements were taken using a digital Vernier caliper to ensure precision.
Each measurement was recorded three times, and the average value was documented to
reduce intra-examiner variability.

2.2.1 Measurement of Occlusal Vertical Dimension (OVD) (Color Plates)

1. The subject was seated in an upright position, and the head was stabilized in a natural
head posture.
2. The subject was asked to occlude in maximum intercuspation (habitual bite).
3. The distance between the tip of the nose and the most prominent point on the chin was
measured using the digital Vernier caliper.

2.2.2 Measurement of Thumb Length (Color Plates)

1. The proximal point was marked on the radial side of the first metacarpophalangeal
joint crease.
2. The distal point was marked at the tip of the thumb (dactylion).
3. The measurement was taken with the digital Vernier caliper, and the mean of right and
left thumb lengths was recorded.

2.2.3 Measurement of Tip of Thumb to Tip of Index Finger Length (Color Plates)

1. The subject was asked to extend the thumb and index finger in a straight position.
2. The distance between the tip of the thumb and the tip of the index finger was
measured using the Vernier caliper.
3. The mean of both hands was recorded.

2.2.4 Measurement of Rima Oris (Corner of Mouth) to Center of Pupil Distance (Color
Plates)

1. The subject was seated in an upright position, looking straight ahead.

2. The distance between the corner of the mouth (rima oris) and the center of the pupil
was measured with a digital Vernier caliper.
3. The mean value from both sides of the face was recorded.

23
 MATERIAL AND METHODS

2.2.5 Measurement of Outer Canthus (Eye) to Tragus of the Ear Distance (Color Plates)

1. The subject was instructed to maintain a natural head position.

2. The distance from the lateral border of the outer canthus of the eye to the tragus of the
ear was measured using the digital Vernier caliper.
3. Measurements were recorded for both right and left sides, and the mean value was
used for analysis.

3. STATISTICAL ANALYSIS

All data were entered into a computer by giving coding system, proofed for entry errors

 Data obtained was compiled on a MS Office Excel Sheet (v 2019, Microsoft

Redmond Campus, Redmond, Washington, United States).

 Data was subjected to statistical analysis using Statistical package for social sciences

(SPSS v 26.0, IBM).

Normality of numerical data was checked using Shapiro-Wilk test & was found that the data

did not follow a normal curve; or for graded data, hence non-parametric tests have been

used for comparisons.

 Inter group comparison (2 groups) was done using Mann Whitney U test.

 Bivariate correlation between 2 numerical variables was checked using

Spearman’s coefficient

For all the statistical tests, p<0.05 was considered to be statistically significant, keeping α

error at 5% and β error at 20%, thus giving a power to the study as 80%.

* = statistically significant difference (p<0.05)

** = statistically highly significant difference (p<0.01)
# = non significant difference (p>0.05)

24
COLOR PLATES
 RESULTS AND OBSERVATION

RESULTS AND OBSERVATION

The results of this study are based on data collected from a total of 200 dentulous

participants, comprising 100 males and 100 females. The primary aim was to explore the

relationship between the occlusal vertical dimension (OVD) and a set of selected

anthropometric parameters—namely, thumb length, thumb-to-index finger distance, the

distance from the corner of the mouth to the center of the pupil, and the distance from the

outer canthus of the eye to the tragus of the ear. All collected data were coded systematically

and entered into a computer spreadsheet. Accuracy of data entry was verified to minimize

transcription errors. The dataset was compiled using Microsoft Excel (v2019, Microsoft

Corporation, Redmond, Washington, USA) and subsequently analyzed using the Statistical

Package for the Social Sciences (SPSS v26.0, IBM Corp.).

To begin with, descriptive statistics were computed for each variable. The association

between OVD and the measured anthropometric parameters was evaluated using Spearman’s

correlation coefficient, given the non-parametric nature of the data. Additionally, Mann-

Whitney U tests were used to examine potential differences between male and female

participants.

For clarity and coherence, the findings are organized into three key sections:

1. Descriptive statistics and Inferential Statistics.

2. Correlation analysis, and

25
 RESULTS AND OBSERVATION

[Link] statistics and Inferential Statistics

Table 1 compares occlusal vertical dimension (Z) across various anthropometric parameters

—including thumb length (A), thumb to index finger distance (B), corner of mouth to pupil

distance (C), and outer canthus to tragus distance (D) between two genders-Males(Gender 1)

and Females(Gender 2) using Mann Whitney U test

Graph 1a-e describes the mean OVD(Z), thumb length (A), thumb to index finger distance

(B), corner of mouth to pupil distance (C), and outer canthus to tragus distance (D)

respectively across both the genders.

For OVD (Z), males demonstrated a higher mean value (62.38 ± 6.36 mm) compared to

females (59.56 ± 6.73 mm), with a median of 62.35 mm and 70.33 mm respectively. The

difference was found to be statistically highly significant (p = 0.003**).

In terms of thumb length:

 Right side: Males showed a higher mean of 64.33 (SD = 6.062) with a median of

64, compared to females (mean = 60.48, SD = 4.723, median = 70.30; p

=0.000**).

 Left side: Males had a mean of 64.25 (SD = 6.035) and median of 64, while

females had a mean of 60.41 (SD = 4.747) and median of 70.35 (p =0.000**).

 Average thumb length was also greater in males (mean = 64.29, SD = 6.045,

median = 64) compared to females (mean = 60.44, SD = 4.734, median = 61.78;

p=0.000**).

26
 RESULTS AND OBSERVATION

For the tip of thumb to tip of index finger distance:

 Right side: Males had a mean of 60.67 (SD = 6.356) and median of 61.10; females

had a mean of 56.77 (SD = 5.575) and median of 61.75 (p =0.000**).

 Left side: Males had a mean of 60.48 (SD = 6.416) and median of 60.90; Females

had a mean of 56.68 (SD = 5.727) and median of 61.80 (p = 0.000**).

 Average: Males (mean = 60.57, SD = 6.374, median = 60.85) showed greater

value than females (mean = 56.73, SD = 5.642, median = 56.68; p = 0.000**).

With regard to the corner of mouth to center of pupil distance:

 Right side: Males (mean = 65.91, SD = 4.408, median = 65.55) scored higher than

Females (mean = 62.25, SD = 4.451, median = 56.55; p = 0.000**).

 Left side: Males had a mean of 65.74 (SD = 4.407) and median of 65.30, while

Females had a mean of 62.20 (SD = 4.451) and median of 56.80 (p = 0.000**).

 Average: Males (mean = 65.83, SD = 4.402, median = 65.43) was significantly

higher than Females (mean = 62.22, SD = 4.451, median = 60.05; p = 0.000**).

For the outer canthus of eye to tragus of ear distance:

 Right side: Males had a mean of 74.07 (SD = 4.768) and median of 73.25, while

Females had a mean of 70.95 (SD = 3.913) and median of 60.00 (p = 0.000**).

 Left side: Males had a mean of 73.98 (SD = 4.733) and median of 73.15; Females

had a mean of 70.93 (SD = 3.923) and median of 60.10 (p = 0.000**).

 Average: Males (mean = 74.03, SD = 4.749, median = 73.20) showed

significantly higher values than Females (mean = 70.94, SD = 3.917, median =

59.20; p = 0.000**).

27
 RESULTS AND OBSERVATION

[Link] Analysis:

The relationship between OVD and various anthropometric parameters was analyzed using

Spearman’s rank correlation coefficient, as the data did not follow a normal distribution.

The anthropometric parameters assessed included thumb length (right, left, average), tip of

thumb to tip of index finger length (right, left, average), corner of the mouth to center of

the pupil, and the distance from the outer canthus of the eye to the tragus of the ear

(right, left, average)

[Link]:

Table 2 presents Spearman’s rank-order correlation coefficients (ρ) examining the

relationships between occlusal vertical dimension (Z) and various anthropometric

parameters- including thumb length (A), thumb to index finger distance (B), corner of mouth

to pupil distance (C), and outer canthus to tragus distance (D), as well as inter-correlations

among those parameters amongst the male samples.

A strong and statistically highly significant positive correlation was found between OVD and:

 Right thumb length (ρ = 0.674, p = 0.000**)

 Left thumb length (ρ = 0.681, p = 0.000**)

 Average thumb length (ρ = 0.680, p = 0.000**)

A weak but statistically significant positive correlation was observed between OVD and:

 Right tip of thumb to tip of index finger length (ρ = 0.288, p = 0.004**)

 Left tip of thumb to tip of index finger length (ρ = 0.305, p = 0.002**)

 Average tip of thumb to tip of index finger length (ρ = 0.296, p = 0.003**)

28
 RESULTS AND OBSERVATION

The distance from the corner of the mouth to center of the pupil and outer canthus of the eye

to the tragus of the ear demonstrated a weak and non-significant relationship with

OVD(p>0.05) .

[Link]:

Table 3 presents Spearman’s rank-order correlation coefficients (ρ) examining the

relationships between occlusal vertical dimension (Z) and various anthropometric

parameters- including thumb length (A), thumb to index finger distance (B), corner of mouth

to pupil distance (C), and outer canthus to tragus distance (D), as well as inter-correlations

among those parameters amongst the female samples

A weak but statistically significant positive correlation was observed between OVD and:

 Right thumb length ρ = 0.200, p = 0.046*

 Left thumb length ρ = 0.200, p = 0.046*

 Average thumb length ρ = 0.201, p = 0.045*

The tip of thumb to tip of index finger distance showed a moderate and statistically highly

significant correlation with OVD:

 Right side: ρ = 0.523, p =0.000**

 Left side: ρ = 0.524, p =0.000**

 Average: ρ = 0.523, p = 0.000**

A weak but statistically significant correlation was also found between OVD and the corner

of the mouth to center of the pupil distance:

 Right side: ρ = 0.204, p = 0.041*

29
 RESULTS AND OBSERVATION

 Left side: ρ = 0.210, p = 0.036*

 Average: ρ = 0.206, p = 0.039*

The outer canthus of the eye to the tragus of the ear distance showed no statistically

significant correlation with OVD:

 Right side: ρ = 0.147, p = 0.143

 Left side: ρ = 0.144, p = 0.153

 Average: ρ = 0.145, p = 0.150

30
DISCUSSION
 DISCUSSION

DISCUSSION

The precise and accurate determination of the Occlusal Vertical Dimension (OVD)

constitutes a foundational and indispensable element in the domain of prosthodontic

rehabilitation. It plays a pivotal role in ensuring both optimal functional performance and

harmonious esthetic outcomes. The OVD refers to the vertical measurement between two

selected anatomical points, typically one on the maxilla and one on the mandible, when the

teeth or prostheses are in contact. This parameter holds particular significance in the

treatment of edentulous patients—individuals who have lost all of their natural teeth—where

complete dentition is absent and extensive, ongoing resorption of the alveolar ridge further

complicates the clinical landscape. In such cases, restoring the appropriate vertical dimension

is not merely a matter of replacing missing teeth, but involves re-establishing the patient’s

ability to perform fundamental oral functions efficiently and comfortably, as well as

maintaining or enhancing the esthetic balance of the face, particularly in the lower third

region [1].

The functional importance of OVD is multifactorial, extending beyond mastication

(chewing) and into essential processes such as phonation (speech production) and deglutition

(swallowing). Furthermore, it significantly contributes to the visual and esthetic configuration

of the face. An optimal OVD is integral to maintaining the height and symmetry of the lower

facial third, which in turn plays a central role in preserving a youthful and aesthetically

pleasing appearance. This region, comprising the chin, lips, and surrounding soft tissue, is

particularly vulnerable to distortion when the vertical dimension is not accurately restored.

Even minor discrepancies in this dimension can result in profound changes in facial

31
 DISCUSSION

expression, muscular tension, and occlusal dynamics, emphasizing the need for careful and

meticulous measurement and restoration during prosthodontic treatment planning [1].

When the OVD is not accurately re-established—whether it is increased beyond the

physiologic norm or reduced below acceptable limits—it can precipitate a broad spectrum of

adverse clinical outcomes. For instance, an excessive increase in vertical dimension can lead

to muscular strain in the masticatory and perioral musculature, difficulty in achieving full lip

closure, and interference with phonetic function. Conversely, an underestimation of OVD

may result in a condition commonly referred to as a “collapsed bite,” where the distance

between the maxilla and mandible is insufficient to support the vertical facial height,

producing sunken cheeks, deepened nasolabial folds, and an aged or fatigued appearance.

Additionally, an inappropriate OVD may also be associated with temporomandibular joint

(TMJ) dysfunction, characterized by pain, joint clicking or popping, and restricted

mandibular movements. Such dysfunctions can, over time, lead to further occlusal instability,

compromise of prosthesis retention, and even psychological distress due to esthetic and

functional dissatisfaction [1][52][53].

Historically, the clinical community has relied upon a number of conventional and

semi-subjective methods to estimate and record the appropriate OVD during prosthodontic

rehabilitation. These include phonetic assessments, such as analyzing the production of

specific sounds like “s” and “m,” which are believed to provide insight into the natural rest

position of the mandible; facial and esthetic evaluations based on soft tissue harmony and

symmetry; functional assessments like swallowing techniques that indicate natural

mandibular positioning; and referencing pre-extraction records or worn dentures that may

provide clues to the patient's original OVD. While each of these approaches contributes

useful data points, they are inherently subjective and depend heavily on the individual

32
 DISCUSSION

clinician’s observational skill, interpretative ability, and experience. This dependence

introduces substantial variability—not only between different clinicians (inter-examiner

variability) but also for the same clinician assessing the same patient at different times (intra-

examiner variability) [54]. Moreover, diverse cultural, ethnic, and anatomical characteristics

across patient populations add another layer of complexity, making it challenging to establish

a universally applicable standard using these traditional methods alone.

Given these inherent limitations of conventional techniques, the use of anthropometric

measurements has gained increasing attention as a potentially valuable, evidence-based

adjunct to clinical practice in recent years. Anthropometry involves the scientific study and

systematic quantification of the human body’s physical dimensions, including bone lengths,

joint distances, and soft tissue contours. The use of anthropometric principles offers several

distinct advantages: it is non-invasive, cost-effective, reproducible, and less dependent on

patient cooperation or subjective clinical interpretation. These features make anthropometry

an appealing option for standardizing OVD estimation, especially in complex cases where

other methods may yield ambiguous or conflicting data [50],[51].

Anthropometric measurements are particularly advantageous because they are based

on skeletal and soft-tissue landmarks that remain relatively stable over time and are less

influenced by temporary physiological changes or intraoral conditions. By identifying

consistent anatomical relationships between these external landmarks and the OVD,

clinicians may be able to develop more objective protocols for diagnosis and treatment

planning. Furthermore, such methods offer the potential to create demographic- or

population-specific reference values, thereby improving accuracy in diverse clinical settings.

33
 DISCUSSION

With the growing body of literature supporting the use of anthropometry in dental

diagnostics, the current study was undertaken with the goal of investigating and quantifying

the relationship between OVD and selected anthropometric parameters. Specifically, the

study aimed to assess whether there is a statistically significant correlation between vertical

dimension and certain easily measurable external body features. The parameters chosen for

evaluation included:

(1) the length of the thumb,

(2) the distance between the tips of the thumb and index finger when extended,

(3) the distance from the corner of the mouth to the center of the ipsilateral pupil, and

(4) the linear measurement from the outer canthus of the eye (lateral corner) to the

tragus of the ear.

These anatomical references were selected based on their prevalence in prior studies, which

suggested they may have a proportional or anatomical relationship to vertical facial height

and occlusal dimensions [13-48].

To ensure the generalizability and reliability of the study’s findings, a balanced and

demographically representative sample was selected. A total of 200 dentulous individuals

were included in the research, with equal representation from both genders—100 males and

100 females. This allowed for the examination of potential gender-based differences in the

anthropometric prediction of OVD and enabled the generation of gender-specific reference

values. Such differentiation is essential because craniofacial morphology often differs

significantly between males and females due to genetic, hormonal, and developmental

factors.

34
 DISCUSSION

Through systematic analysis and comparison of these anthropometric markers with

measured OVD values, the study sought to determine whether a predictable, reproducible

relationship exists that could be integrated into daily prosthodontic practice. The ultimate aim

is to establish a clinically viable protocol whereby external anatomical measurements can

serve as reliable indicators for estimating the appropriate OVD in both edentulous and

dentulous populations. The integration of such findings into routine clinical workflows could

dramatically enhance treatment planning accuracy, reduce reliance on subjective estimations,

and improve patient outcomes, particularly in geriatric patients or those with compromised

neuromuscular coordination who may struggle with conventional assessment techniques. In

the long term, this approach could also contribute to the creation of population-specific OVD

standards, enabling culturally and anatomically tailored prosthodontic care on a global scale.

Occlusal Vertical Dimension (OVD): Gender Differences

The results of the study demonstrated that the average OVD was significantly higher

in males (62.38 ± 6.36 mm) compared to females (59.56 ± 6.73 mm). This observation

corroborates the findings of earlier researchers such as Chidambaranathan AS et al.[55] and

Kamboj E et al.,[44] who also reported gender-based differences in vertical facial proportions.

These differences may be attributed to the generally larger craniofacial dimensions and

skeletal mass in males compared to females, influenced by both genetic and hormonal factors
[56].
This reinforces the necessity of gender-specific standards when assessing and restoring

vertical dimension in clinical prosthodontics. Ignoring such differences could result in over-

or under-estimation of the OVD, potentially leading to compromised prosthetic outcomes,

temporomandibular joint discomfort, or esthetic dissatisfaction.

1. Thumb Length vs. OVD

35
 DISCUSSION

Among the anthropometric measurements evaluated, thumb length exhibited the most

robust and consistent correlation with OVD in the male subgroup. The correlation coefficient

of approximately ρ ≈ 0.68 (p < 0.001) reflects a strong, statistically significant positive

relationship. This suggests that in males, thumb length can serve as a reliable, reproducible

anatomical marker for estimating OVD.

In contrast, among females, the correlation between thumb length and OVD, although

statistically significant (ρ ≈ 0.20, p < 0.05), was notably weaker. This disparity may arise due

to greater variability in soft tissue distribution and skeletal structure among women, possibly

influenced by hormonal fluctuations, body fat distribution, or genetic diversity.[57] These

findings align with the results reported by Khanehzad M et al.[29] and Basnet BB et al.[24] ,

supporting the relevance of thumb length as a predictive parameter, especially in males.

From a clinical standpoint, the thumb length can be easily measured using a simple

caliper or measuring tape and used as a reference during jaw relation procedures, especially

in resource-limited settings or among patients with diminished neuromuscular control.

2. Thumb-to-Index Finger Distance vs. OVD

The inter-digital distance between the thumb and index finger when maximally

abducted also showed a statistically significant, albeit weaker, correlation with OVD in

males. This could imply that in males, while thumb length serves as the primary skeletal

marker, hand span contributes additional—but less precise—information. Interestingly, in

females, the correlation between this parameter and OVD was stronger (ρ ≈ 0.52, p < 0.001),

indicating a moderate and statistically significant relationship. These results agree with

Tripathi S et al.,[31] who also concluded that while thumb length was a more reliable indicator

in males, the thumb-to-index finger distance had better predictive accuracy in females.

36
 DISCUSSION

The plausible reason for gender-based variation may reflect differing anatomical

proportions and biomechanics of hand function between the sexes. [58]

Clinically, this measurement is advantageous as it does not require any specific

instrumentation and can be quickly obtained at the chairside. It may be particularly useful in

patients where direct facial measurements are difficult due to scarring, asymmetry, or

syndromic conditions affecting craniofacial structures.

3. Corner of the Mouth to Center of Pupil vs. OVD

This parameter, a facial measurement extending diagonally from the corner of the

mouth to the center of the pupil, was evaluated for its potential correlation with OVD. In

males, the analysis revealed no statistically significant correlation, suggesting limited clinical

utility. However, in females, a weak yet statistically significant correlation was observed.

These findings resonate with the results of Nagpal A et al., [23] who also questioned the

reliability of this measurement due to its susceptibility to soft tissue variations and dynamic

facial expressions. Contrastingly, a study by Alhajj MN et al.[25] indicated a significant

relationship in a different population, pointing towards potential ethnic and demographic

variability in the reliability of this measurement. Given the inconsistency in results and its

susceptibility to facial muscle tone and symmetry, this parameter should be interpreted with

caution and not be solely relied upon in the clinical estimation of OVD.[59]

4. Outer Canthus of Eye to Tragus of Ear vs. OVD

Traditionally, the distance from the outer canthus of the eye to the tragus of the ear

has been used as a reference in facial analysis, particularly in dividing the face into thirds.

37
 DISCUSSION

However, this study found no statistically significant correlation between this parameter and

OVD in either gender group. The lack of correlation may be due to high inter-individual

variability in ear positioning, facial symmetry, and soft tissue characteristics, which can

distort linear facial measurements.[60]

These findings contradict those of Khanehzad M et al.,[29] who observed a meaningful

correlation in an Iranian cohort. This discrepancy further underscores the necessity of

validating such anthropometric landmarks across different ethnic and racial populations

before incorporating them into universal clinical practice. From a prosthodontic perspective,

reliance on this parameter for determining OVD appears to be of limited value, and its use

should be limited to supplementary or confirmatory roles rather than as a primary

determinant.

Clinical Implications

The findings of this study hold practical significance in the context of prosthodontic

treatment planning. The observed gender-specific patterns suggest that different

anthropometric parameters may be more predictive of OVD in males and females:

 For males, thumb length stands out as the most consistent, reproducible, and robust

anthropometric predictor of OVD. Its skeletal nature and minimal variation with age

make it particularly suitable for elderly or edentulous patients.

 For females, the thumb-to-index finger distance offers better predictive value,

possibly reflecting gender-specific body proportions and craniofacial harmony.

By incorporating these easily measurable, non-invasive parameters into routine clinical

practice, practitioners can enhance diagnostic accuracy, minimize reliance on subjective

38
 DISCUSSION

assessments, and reduce chairside time. This is particularly beneficial in cases involving

uncooperative, elderly, or communication-impaired patients where traditional methods may

be impractical.

Recommendations for Future Research

While the present investigation has made meaningful contributions by highlighting a

potential relationship between occlusal vertical dimension (OVD) and selected external

anthropometric parameters, it also opens up several avenues for more comprehensive

exploration. The current findings, though valuable, must be further validated, diversified, and

refined to ensure broader clinical applicability across variable patient profiles, treatment

modalities, and geographic regions. Consequently, future research initiatives should aim to

deepen the understanding of this correlation through a more expansive and multidisciplinary

lens. The following recommendations are proposed for guiding subsequent studies and for

enriching the evidence base that informs prosthodontic diagnostics and interventions:

1. Inclusion of Edentulous and Partially Edentulous Patients:

As this study was limited to dentulous individuals, it is crucial to replicate the analysis

in completely edentulous and partially edentulous populations. These patients often

present with altered facial anatomy due to bone resorption and loss of vertical

dimension, making anthropometric landmarks potentially more variable. Assessing the

reliability of these parameters in such clinical situations can greatly inform

prosthodontic planning and denture fabrication.

2. Age Stratification and Longitudinal Evaluation:

Future studies should consider stratifying participants by age groups (e.g., young adults,

middle-aged, elderly) to assess the influence of aging on anthropometric-OVD

39
 DISCUSSION

correlations. A longitudinal design could also be employed to evaluate how these

measurements change over time and whether they maintain their predictive validity as

individuals age.

3. Cross-Ethnic and Cross-Geographical Validation:

Anthropometric features may vary significantly across different ethnic groups and

geographical populations due to genetic and environmental influences. Multi-center

studies involving diverse demographic cohorts are recommended to develop ethnically

tailored reference ranges for OVD estimation, thereby enhancing clinical applicability in

global practice.

4. Gender-Specific Predictive Modeling:

Given the apparent gender differences observed in this study, future research could

explore regression models or artificial intelligence-based algorithms that use gender-

specific anthropometric inputs to predict OVD more accurately. This approach could

help automate and standardize assessments in both clinical and educational settings.

5. Influence of Body Mass Index (BMI) and Facial Morphotypes:

Since soft tissue distribution can vary with body composition, investigating the role of

BMI and facial morphotypes (e.g., mesoprosopic, euryprosopic, leptoprosopic) could

further refine the utility of anthropometric markers. Correlating these variables may help

determine whether certain facial types are more amenable to specific OVD estimation

methods.

6. Use of Advanced Imaging and Digital Technologies:

Integration of three-dimensional facial scanning, digital anthropometry, and cone-beam

computed tomography (CBCT) could increase the precision and reproducibility of

measurements, while minimizing operator error. These technologies may also allow for

automated landmark identification and dynamic simulation of prosthetic outcomes.

40
 DISCUSSION

7. Application in Pediatric and Orthodontic Populations:

Exploring the applicability of anthropometric-based OVD prediction in growing

children and adolescents, particularly those undergoing orthodontic or orthopedic

treatment, could provide insights into craniofacial development and guide early

interventions.

8. Functional Outcomes and Patient Satisfaction:

Future studies should not only focus on anthropometric correlations but also assess

clinical functional outcomes such as masticatory efficiency, phonetic clarity, and

patient-reported satisfaction post-rehabilitation. This would help establish a stronger

evidence base linking anthropometric estimations to real-world prosthodontic success.

9. Development of Standardized Protocols and Training Modules:

Once validated, there is a need to develop standardized clinical protocols and

educational modules to train dental students and practitioners in applying

anthropometric methods effectively. Ensuring uniform measurement techniques across

practitioners will be vital to maximizing inter-clinician reliability.

10. Comparative Studies with Conventional Methods:

Further comparative research between anthropometric methods and traditional

techniques (like phonetics, esthetics, and mechanical methods) will help determine the

relative advantages, limitations, and best-use scenarios of each approach in a range of

clinical conditions.

11. Exploration of Dynamic Anthropometry and Muscle Activity Correlations:

Future research could investigate how dynamic changes in facial landmarks during

function (e.g., speaking, chewing, and swallowing) affect OVD estimations.

Electromyography (EMG) could be utilized to correlate muscle activity patterns with

vertical dimension, adding a functional layer to anatomical measurement. Understanding

41
 DISCUSSION

how OVD interacts with neuromuscular control could pave the way for more

physiologically based prosthodontic reconstructions.

In conclusion, while anthropometric parameters show promise as supplementary tools for

determining OVD, their use should be contextualized based on gender, population

characteristics, and the overall clinical picture

42
SUMMARY AND
CONCLUSION
 SUMMARY AND CONCLUSION

SUMMARY AND CONCLUSION

The accurate determination of the Occlusal Vertical Dimension (OVD) is fundamental

to achieving optimal outcomes in prosthodontic rehabilitation, particularly in edentulous

patients where conventional landmarks and occlusal references are often lost. This study

aimed to investigate the correlation between OVD and various anthropometric parameters—

namely thumb length, thumb-to-index finger distance, the distance from the corner of the

mouth to the center of the pupil, and the distance from the outer canthus of the eye to the

tragus of the ear—among a cohort of 200 dentulous individuals, equally divided between

males and females.

The results revealed notable gender differences in OVD values, with males exhibiting

significantly higher mean OVD than females. Among the anthropometric indicators

evaluated, thumb length showed the strongest and most statistically significant positive

correlation with OVD in males, suggesting its utility as a reliable anatomical marker in

clinical practice. In contrast, the thumb-to-index finger distance demonstrated a stronger

correlation with OVD in females, indicating a potential gender-specific anthropometric

predictor. Other facial parameters such as the corner of the mouth to the center of the pupil

exhibited only weak correlations, and the distance from the outer canthus to the tragus of the

ear showed no statistically significant association with OVD in either gender.

These findings underscore the clinical value of incorporating simple, non-invasive

anthropometric measurements into the diagnostic armamentarium of prosthodontics,

particularly in cases where traditional methods are inconclusive or impractical. By identifying

reliable and reproducible markers—tailored by gender—clinicians can enhance the precision

43
 SUMMARY AND CONCLUSION

of OVD determination, reduce subjectivity, and improve patient comfort and treatment

outcomes.

However, while anthropometric approaches hold promise, their application must be

contextualized to account for variations in age, ethnicity, facial morphology, and gender-

based anatomical differences. The study also highlights the importance of developing

population-specific and gender-sensitive guidelines for OVD estimation to increase

diagnostic accuracy and treatment predictability.

In conclusion, the integration of anthropometric analysis, particularly thumb length in

males and thumb-to-index finger distance in females, offers a pragmatic, cost-effective, and

scientifically grounded adjunct to conventional OVD determination methods. Future research

should focus on expanding these findings to edentulous populations, incorporating advanced

digital tools, and developing predictive algorithms that further refine and personalize

prosthodontic rehabilitation protocols.

44
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43
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49
GRAPHS AND TABLES

43
 TABLES AND GRAPHS

p value of
Mean Sum of Mann-Whitney U Mann-
Gender N Mean Std. Deviation Median Z value
Rank Ranks value Whitney
U test
1 100 62.38 6.361 112.61 11260.5 62.35
Z 3789.5 -2.958 0.003**
2 100 59.56 6.725 88.4 8839.5 70.33
1 100 64.33 6.062 118.9 11890 64
A Right 3160 -4.496 0.000**
2 100 60.48 4.723 82.1 8210 70.3
1 100 64.25 6.035 118.66 11866 64
A Left 3184 -4.438 0.000**
2 100 60.41 4.747 82.34 8234 70.35
1 100 64.29 6.045 118.76 11876 64
A Average 3174 -4.462 0.000**
2 100 60.44 4.734 82.24 8224 61.78
1 100 60.67 6.356 118.75 11875 61.1
B Right 3175 -4.46 0.000**
2 100 56.77 5.575 82.25 8225 61.75
1 100 60.48 6.416 118.01 11800.5 60.9
B Left 3249.5 -4.278 0.000**
2 100 56.68 5.727 83 8299.5 61.8
B Average 1 100 60.573 6.3741 118.38 11838 60.85 3212 -4.369 0.000**

43
 2 100 56.727 5.6418 82.62 8262 56.68
1 100 65.912 4.4077 122.75 12275 65.55
C Right 2775 -5.437 0.000**
2 100 62.247 4.4514 78.25 7825 56.55
1 100 65.742 4.4066 122.13 12213 65.3
C Left 2837 -5.286 0.000**
2 100 62.198 4.4514 78.87 7887 56.8
1 100 65.827 4.4017 122.61 12260.5 65.43
C Average 2789.5 -5.401 0.000**
2 100 62.223 4.4508 78.4 7839.5 60.05
1 100 74.07 4.768 121.65 12165 73.25
D Right 2885 -5.169 0.000**
2 100 70.95 3.913 79.35 7935 60
1 100 73.98 4.733 121.28 12127.5 73.15
D Left 2922.5 -5.077 0.000**
2 100 70.93 3.923 79.73 7972.5 60.1
1 100 74.026 4.749 121.43 12142.5 73.2
D Average 2907.5 -5.113 0.000**
2 100 70.944 3.9172 79.58 7957.5 59.2

Mann-Whitney U test; ** indicates statistically highly significant p<0.01

Table 1 compares occlusal vertical dimension (Z) across various anthropometric parameters—including thumb length (A), thumb to index finger

distance (B), corner of mouth to pupil distance (C), and outer canthus to tragus distance (D) between two genders-Males(Gender 1) and

Females(Gender 2)

44
 GRAPHS AND TABLES

Inter Gender comparison of Z

63
62.5 62.38
62
61.5
61 Z
60.5
60 59.56
59.5
59
58.5
58
Male Female

Graph 1a: Bar graph representing the inter-gender comparison of mean occlusal vertical

dimension (Z) values.

Inter Gender comparison of A

65
64.33 64.25 64.29
64

63
A Right
62 A Left
A Average
61 60.48 60.41 60.44
60

59

58
Male Female

Graph 1b: Bar graph showing inter-gender comparison of means of thumb length

measurements (A) on the right side, left side, and their average

43
 GRAPHS AND TABLES

Inter Gender comparison of B

62
61 60.67 60.48 60.573
60
B Right
59
B Left
58 B Average
57 56.77 56.68 56.727

56
55
54
Male Female

Graph 1c: Bar graph representing inter-gender comparison of the means of distance from the

tip of the thumb to the tip of the index finger (B) on the right side, left side, and average

Inter Gender comparison of C

67
65.912 65.742 65.827
66

65
C Right
64 C Left
C Average
63
62.247 62.198 62.223
62

61

60
Male Female

Graph 1d: Bar graph showing inter-gender comparison of the means of distance from the

corner of the mouth to the center of the pupil (C) on the right side, left side, and average.

44
 GRAPHS AND TABLES

Inter Gender comparison of D

75
74.07 73.98 74.026
74

73 D Right
D Left
72 D Average
70.95 70.93 70.944
71

70

69
Male Female

Graph 1e: Bar graph depicting inter-gender comparison of means of the distance from the

outer canthus of the eye to the tragus of the ear (D) on the right side, left side, and average.

45
 Correlations
A B C D
Z A Rt. A Lt B Rt. B Lt C Rt. C Lt D Rt. D Lt
Avg. Avg. Avg. Avg.
Spearman's Correlation
rho Coefficient
Z Sig. (2-
tailed)
N
Correlation
.674**
Coefficient
A Rt Sig. (2-
.000
tailed)
N 100
Correlation
.681** .995**
Coefficient
A Lt Sig. (2-
.000 .000
tailed)
N 100 100
A Correlation .680** .998** .999**
Avg. Coefficient

43
 Sig. (2-
.000 .000 .000
tailed)
N 100 100 100
Correlation
.288** .264** .259** .264**
Coefficient
B
Sig. (2-
Rt. .004 .008 .009 .008
tailed)
N 100 100 100 100
Correlation
.305** .257** .252* .256* .992**
Coefficient
B Lt Sig. (2-
.002 .010 .012 .010 .000
tailed)
N 100 100 100 100 100
Correlation
.296** .262** .257** .262** .998** .997**
Coefficient
B
Sig. (2-
Avg. .003 .008 .010 .008 .000 .000
tailed)
N 100 100 100 100 100 100
C Correlation
.157 .076 .062 .061 .101 .099 .103
Rt. Coefficient
Sig. (2-
.118 .454 .543 .544 .316 .327 .310
tailed)
N 100 100 100 100 100 100 100
44
 Coefficient
Sig. (2-
Avg. .056 .000 .000 .000 .129 .194 .157 .031 .032 .029 .000 .000
tailed)
N 100 100 100 100 100 100 100 100 100 100 100 100
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).
Rt-Right, Lt-Left; Avg.-Average

Table 2 presents Spearman’s rank-order correlation coefficients (ρ) examining the relationships between occlusal vertical dimension (Z) and

various anthropometric parameters- including thumb length (A), thumb to index finger distance (B), corner of mouth to pupil distance (C), and

outer canthus to tragus distance (D), as well as inter-correlations among those parameters amongst the male samples.

Correlations
A B C
D
Z A Rt A Lt Avg B Rt B Lt Avg C Rt C Lt Av D Rt D Lt
Avg.
. . g.

45
Spearma Correlati
n's rho on
Coefficie
Z nt
Sig. (2-
tailed)
N
Correlati
on
.200*
Coefficie
A
nt
Rt
Sig. (2-
.046
tailed)
N 100
Correlati
on .998
.200* **
Coefficie
A
nt
Lt
Sig. (2-
.046 .000
tailed)
N 100 100
A Correlati .201* .999 .999

46
 on
** **
Coefficie
Av nt
g. Sig. (2-
.045 .000 .000
tailed)
N 100 100 100
Correlati
on .523* .283 .273 .279
* ** ** **
Coefficie
B
nt
Rt
Sig. (2-
.000 .004 .006 .005
tailed)
N 100 100 100 100
Correlati
on .524* .289 .280 .286 .998
* ** ** ** **
Coefficie
B
nt
Lt
Sig. (2-
.000 .004 .005 .004 .000
tailed)
N 100 100 100 100 100
B Correlati .523* .289 .279 .285 .999 1.000
on

47
 Coefficie * ** ** ** ** **

nt
Av
Sig. (2-
g. .000 .004 .005 .004 .000 .000
tailed)
N 100 100 100 100 100 100
Correlati
on .252 .256
.204* .073 .073 .073 *
.260** *
Coefficie
C
nt
Rt
Sig. (2-
.041 .470 .473 .469 .011 .009 .010
tailed)
N 100 100 100 100 100 100 100
Correlati
on .260 .264
.210* .066 .065 .066 **
.268** **
.999**
Coefficie
C
nt
Lt
Sig. (2-
.036 .515 .519 .515 .009 .007 .008 .000
tailed)
N 100 100 100 100 100 100 100 100
C Correlati .206* .072 .072 .072 .255 .263** .259 1.000 .999
* ** ** **
Av on
Coefficie

48
 nt
Sig. (2-
g. .039 .474 .477 .474 .010 .008 .009 .000 .000
tailed)
N 100 100 100 100 100 100 100 100 100
Correlati
on .216 .221 .218 .220 .22
.147 * * *
.182 .179 .180 .218* *
Coefficie 0*
D
nt
Rt
Sig. (2- .02
.143 .031 .027 .029 .071 .075 .073 .029 .028
tailed) 8
N 100 100 100 100 100 100 100 100 100 100
Correlati
on .215 .220 .217 .215 .21 .997
.144 * * *
.187 .184 .186 .213* *
Coefficie 4* **

D
nt
Lt
Sig. (2- .03
.153 .032 .028 .030 .063 .067 .064 .033 .032 .000
tailed) 2
N 100 100 100 100 100 100 100 100 100 100 100
D Correlati .145 .214 .219 .217 .185 .182 .184 .215* .217 .21 .999 .999
* * * *
Av on 6* ** **

Coefficie

49
 nt
Sig. (2- .03
g. .150 .032 .028 .030 .066 .070 .068 .032 .030 .000 .000
tailed) 1
N 100 100 100 100 100 100 100 100 100 100 100 100
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).
Rt-Right, Lt-Left; Avg.-Average

Table 3 presents Spearman’s rank-order correlation coefficients (ρ) examining the relationships between occlusal vertical dimension (Z) and

various anthropometric parameters- including thumb length (A), thumb to index finger distance (B), corner of mouth to pupil distance (C), and

outer canthus to tragus distance (D), as well as inter-correlations among those parameters amongst the female samples

50
ANNEXURES

43
ANNEXURE 1-CASE HISTORY

43
 ANNEXURE 2-TEST OF NORMALITY

Shapiro-Wilk
Statistic df p value
Gender
Z 1 .993 100 .894
2 .978 100 .101
A Right 1 .991 100 .728
2 .972 100 .032
A Left 1 .991 100 .733
2 .976 100 .061
A Average 1 .991 100 .719
2 .974 100 .046
B Right 1 .986 100 .368
2 .985 100 .340
B Left 1 .985 100 .333
2 .989 100 .614
B Average 1 .985 100 .309
2 .987 100 .457
C Right 1 .988 100 .482
2 .970 100 .022
C Left 1 .987 100 .409
2 .971 100 .026
C Average 1 .988 100 .479
2 .971 100 .025
D Right 1 .981 100 .154
2 .960 100 .004
D Left 1 .980 100 .136
2 .960 100 .004
D Average 1 .981 100 .146
2 .960 100 .004

p<0.05 indicates normality not followed

44
 MASTER TABLES

Occlusal Thumb Length [A] Tip of thumb to tip of Corner of mouth to Lateral border of the
[Link] Vertical the index finger centre of pupil of eye outer canthus (eye) to the
. Dimension(Z) length [B] [C] tragus of the ear [D]
(in mm) Righ Averag Averag
Right Left Average t Left e Right Left e Right Left Average

45
 1 68 64 64 64 63 62 62.5 67.5 67.5 67.5 71 70 70.5
2 69 70 70.1 70.05 60 60.1 60.05 72.4 72.3 72.35 81 80 80.5
3 66 68 68.2 68.1 61.2 61.1 61.15 73.4 73.2 73.3 71 71 71
4 63.5 68 68 68 64 64 64 65.3 65.2 65.25 80 80 80
5 63 64.4 64 64.2 65.2 65.2 65.2 69.8 69.7 69.75 75.3 75.2 75.25
6 62.5 66 66 66 63.3 63.1 63.2 63.2 63.1 63.15 76.4 75.3 75.85
7 58.4 66.6 66.5 66.55 64.4 64.2 64.3 64.2 64.1 64.15 79 79.1 79.05
8 53.9 57 57 57 46.5 45.9 46.2 66.7 66.3 66.5 71 71.2 71.1
9 57.9 66.1 66 66.05 63.9 63.7 63.8 68.3 68.2 68.25 79.5 79.4 79.45
10 63.9 69.5 69.4 69.45 64.4 64.2 64.3 71 71 71 83.8 83.7 83.75
11 62.2 55 55 55 64 64 64 72.7 72.3 72.5 75.7 75.6 75.65
12 64 68.2 68 68.1 54.3 54.3 54.3 62.2 62.1 62.15 73.7 73.6 73.65
13 54.4 50.1 50 50.05 54 54 54 67.9 67.3 67.6 70.7 70.7 70.7
14 58 55 55 55 51.7 51.7 51.7 60.9 60.4 60.65 73 73.1 73.05
15 61.5 62.1 62 62.05 55.2 55.1 55.15 70.3 70.2 70.25 70.6 70.3 70.45
16 56.2 58.9 58.9 58.9 54.6 54.3 54.45 63.8 63.7 63.75 70.5 70.3 70.4
17 58.8 56.5 56.4 56.45 62.3 62.2 62.25 65.6 65.3 65.45 70.4 70.3 70.35
18 62.3 55.8 55.8 55.8 67.5 67.3 67.4 65.7 65.7 65.7 72.8 72.7 72.75
19 47.4 63.7 63.8 63.75 51 51.2 51.1 64.1 64.1 64.1 71.3 71.2 71.25
20 55.9 63.8 63.7 63.75 56.9 56.8 56.85 70.5 70.5 70.5 72.3 72.2 72.25
21 58.8 56.5 56.5 56.5 62.3 62.2 62.25 65.6 65.3 65.45 70.5 70.3 70.4
22 57.2 66.7 66.8 66.75 61 60 60.5 65.1 65.2 65.15 73.9 73.8 73.85
23 52.9 62.3 62.3 62.3 58.2 51.1 54.65 71.9 71.8 71.85 77.7 77.3 77.5
24 51.5 61.8 61.7 61.75 61.2 61.1 61.15 61 62 61.5 78.9 78.5 78.7
25 62.4 67.3 67.3 67.3 58.6 58.2 58.4 58.4 58.3 58.35 72.9 72.3 72.6
26 55.4 60.2 60.2 60.2 60.2 60.1 60.15 61.1 61.2 61.15 78.3 78.3 78.3
27 69.5 68.3 68.4 68.35 55.8 55.3 55.55 64.9 64.8 64.85 80.9 80.5 80.7
28 59.5 60.7 60.7 60.7 54.6 53.1 53.85 68.6 68.3 68.45 82.7 82.6 82.65
29 59.3 68.3 68.3 68.3 54.3 54.2 54.25 67.5 67.3 67.4 84 84 84
30 76 66.5 66.5 66.5 67.8 67.5 67.65 73.7 73.7 73.7 78.4 78.3 78.35
31 72.8 70.4 70.4 70.4 74.8 74.3 74.55 69.6 68.7 69.15 78.4 78.3 78.35
32 77.2 78.4 78.3 78.35 58.4 58.3 58.35 69 69 69 78.3 78.3 78.3
33 66.5 70.7 70.8 70.75 59.4 59.2 59.3 59.9 59.8 59.85 70.7 70.7 70.7
34 58.8 75.2 75.2 75.2 75.1 75 75.05 64.4 64.3 64.35 75.2 75.1 75.15
35 70.9 72.4 72.3 72.35 64.3 64.2 64.25 62.2 62.3 62.25 78.6 78.5 78.55
MASTER TABLE-MALE SAMPLES

[Link] Occlusal Thumb Length [A] Tip of thumb to tip of Corner of mouth to Lateral border of the
. Vertical the index finger length centre of pupil of eye outer canthus (eye) to
Dimension [B] [C] the tragus of the ear [D]
(Z) (in
mm)
Right Left Average Right Left Averag Right Left Average Righ Left Average

46
 e t
36 63.9 77.3 77.2 77.25 55.5 55.3 55.4 64.1 64 64.05 73.3 73.2 73.25
37 60.6 64.4 64.3 64.35 53.6 52.1 52.85 56 56 56 77.1 77 77.05
38 69.2 69.2 69.3 69.25 52.1 52 52.05 69.2 69 69.1 79.2 79.1 79.15
39 70.4 70.3 70.3 70.3 66.2 66 66.1 65.6 65.3 65.45 79.1 79.2 79.15
40 70.3 68 68 68 49 49 49 71.9 71 71.45 75.9 75.8 75.85
60.3
41 67.8 74.6 74.3 74.45 9 60.7 60.545 70.9 70.3 70.6 76 76 76
42 59.3 80 80.1 80.05 64.7 63.7 64.2 61.1 61 61.05 85.6 85.3 85.45
43 66.2 61.7 61.6 61.65 64.7 64.2 64.45 60.8 60 60.4 75.4 75.3 75.35
44 62.4 63 62 62.5 58.6 58.6 58.6 58.4 58.3 58.35 72.9 72.8 72.85
45 69.5 68.3 67.9 68.1 54.2 54.2 54.2 60.2 60 60.1 73.4 73.4 73.4
46 58 75.2 75.1 75.15 75.1 75 75.05 64 64 64 75.3 75.2 75.25
47 71 72.4 71.2 71.8 64 64 64 62.6 62.3 62.45 78 78 78
48 52.9 62 61 61.5 58.2 58.2 58.2 71 71 71 75.4 75.2 75.3
49 67 66 65 65.5 63.2 63 63.1 65.4 65.3 65.35 71.2 71.1 71.15
50 69 70 70 70 60.5 60.2 60.35 72.1 72 72.05 80.4 80.3 80.35
51 65 67.31 67 67.155 61.2 61.1 61.15 73.4 73.3 73.35 71 71 71
52 63.5 64.2 64 64.1 68 68 68 65.5 65 65.25 70.1 70 70.05
53 62.5 63.3 63 63.15 66 66 66 64 64 64 76.4 76.4 76.4
54 58.2 60.1 60 60.05 64.4 64.3 64.35 64.8 64.7 64.75 79 79 79
55 53.9 56 56 56 46.5 46.3 46.4 66.7 66.3 66.5 71 71 71
56 57.5 60 60.1 60.05 62.1 62.2 62.15 65 65.1 65.05 70.1 70 70.05
57 72.8 70.8 70.3 70.55 75.8 75.3 75.55 69.1 69.2 69.15 76.2 76.2 76.2
58 66.5 69.1 69.2 69.15 59.4 59.3 59.35 59.9 59.7 59.8 70.1 70.1 70.1
59 67.2 76 75 75.5 70.2 70.1 70.15 71.2 71.1 71.15 74.2 74.3 74.25
60 71.2 70.2 70.1 70.15 63.4 63.3 63.35 57.9 57.8 57.85 68.2 68.1 68.15
61 65 62 62.1 62.05 69.2 69.1 69.15 60.1 60.1 60.1 63.4 63.3 63.35
62 71 70.4 71.3 70.85 64 64 64 62.6 62.3 62.45 78 78 78
63 63 64.2 64.3 64.25 68 68 68 65.5 65.3 65.4 73 73 73
64 52.9 62.3 62.2 62.25 58.2 58.1 58.15 71.9 70.9 71.4 77 77 77
65 70.9 72.4 72.3 72.35 64.3 64.2 64.25 62.6 62.6 62.6 78.6 78.3 78.45
66 47.4 52 52 52 63.7 63.8 63.75 64.1 64 64.05 71.3 71.2 71.25
67 51.2 61.8 61.7 61.75 61.2 61.1 61.15 61 61 61 78.9 78.7 78.8
68 61.5 62.1 62.2 62.15 53.2 55.3 54.25 70.3 70 70.15 70.6 70.3 70.45
69 62.2 60 60 60 67.1 67.2 67.15 68 68 68 71 71 71
70 60 60.7 60.3 60.5 54.6 54.6 54.6 68.6 68.1 68.35 80 80 80

Sr.N Occlusal Thumb length [A] Tip of thumb to tip of Corner of mouth to Lateral border of the
o. Vertical the index finger centre of pupil of eye outer canthus (eye) to
Dimension(Z) length [B] [C] the tragus of the ear [D]
(in mm)

47
 Righ
t Left Average Right Left Average Right Left Average Right Left Average

71 62.3 60.9 60.8 60.85 67.5 67.3 67.4 65.7 65.3 65.5 72.8 72.6 72.7
72 56 58.1 58.2 58.15 62.3 62.1 62.2 60 60 60 66.1 66.2 66.15
73 49.9 52 52 52 56.2 56.1 56.15 60 60 60 61.1 61.3 61.2
74 67 65.2 65.3 65.25 60.2 60.3 60.25 64.3 64 64.15 70 70.1 70.05
75 63.1 64 64 64 60 60 60 68.9 68 68.45 70.1 70.1 70.1
76 59 60.2 60.3 60.25 64 64 64 66 66 66 68.2 68.1 68.15
77 71.2 70.2 70.1 70.15 65 65 65 69.2 69.1 69.15 76 76.1 76.05
78 56 56.3 55.2 55.75 60 60.1 60.05 65.3 65.3 65.3 66 66.2 66.1
79 63.2 64.3 64.2 64.25 59 59.2 59.1 68 68 68 70.4 70.3 70.35
80 74 62 62 62 73.1 73.1 73.1 78 78.1 78.05 79.4 79.5 79.45
81 66 65.1 65.2 65.15 62.1 62.2 62.15 69 69.1 69.05 73.2 73.1 73.15
82 62 63.4 63.3 63.35 67 67 67 70 70.1 70.05 71.2 71.3 71.25
83 50.2 53.2 54 53.6 56.1 56.2 56.15 62 62.3 62.15 63.5 63.7 63.6
84 62 63.2 63.4 63.3 59 59 59 69.1 69 69.05 71.2 71.3 71.25
85 60 61.3 60.3 60.8 67.2 67.3 67.25 70 70.1 70.05 78.1 78.2 78.15
86 60.6 62.4 62.2 62.3 53.6 53.7 53.65 56 56.2 56.1 77.1 77.2 77.15
87 66.7 69.2 69.1 69.15 56 56.1 56.05 71.9 70 70.95 73 73.1 73.05
88 61.1 63.2 62.1 62.65 65.2 65.3 65.25 70 71 70.5 72.9 72.9 72.9
89 55.7 55.8 55.7 55.75 63.4 63.3 63.35 69 69.1 69.05 72.4 72.3 72.35
90 66.1 65.2 65.3 65.25 45.1 45.2 45.15 68 68.2 68.1 74.7 74.6 74.65
91 57.2 56 56.1 56.05 52.8 52.7 52.75 62 62.1 62.05 68 68 68
92 61.6 64.7 64.3 64.5 60.6 60.3 60.45 61.6 61.3 61.45 70.7 70.7 70.7
93 65.3 64 64 64 56.7 56.8 56.75 59 56.1 57.55 69.6 69.6 69.6
94 61.7 59.9 59.9 59.9 55.8 55.7 55.75 65.2 65.2 65.2 83 83.2 83.1
95 73.4 71 71.1 71.05 69.4 69.3 69.35 66.4 66.1 66.25 68.7 68.7 68.7
96 65.2 59.4 59.3 59.35 47.6 47.2 47.4 65.4 65.3 65.35 67.6 67.3 67.45
97 62.9 63.2 63.1 63.15 60 60 60 65 65 65 79.3 79.2 79.25
98 56.7 55.8 55.7 55.75 53 53 53 67.1 67 67.05 69 69.2 69.1
99 65 60.9 63.8 62.35 61.4 61.3 61.35 59.8 59.7 59.75 69.8 69.5 69.65
100 60.6 61.1 61.3 61.2 53.6 53.3 53.45 65.4 65.3 65.35 69 69.2 69.1

[Link]. Occlusal Thumb Length [A] Tip of thumb to tip of Corner of mouth to Lateral border of the outer
Vertical the index finger length centre of pupil of eye canthus (eye) to the
Dimension [C] tragus of the ear
[B]

48
 [D]
(Z) (in mm)
Right Left Average Right Left Average Right Left Average Right Left Average
1 69 55 55.2 55.1 61.2 61.1 61.15 65 65.1 65.05 75 75.1 75.05
2 68 55.6 55.3 55.45 62.4 62.3 62.35 60 60.2 60.1 81 81.1 81.05
3 52 51.2 50.2 50.7 51.8 51.7 51.75 59 59.2 59.1 69 69 69
4 54.5 57 57.1 57.05 62.3 62.3 62.3 62 62.1 62.05 70.5 70.3 70.4
5 66 57.1 57 57.05 58.9 58.7 58.8 64.3 64.2 64.25 66 66.3 66.15
6 66 57 57.2 57.1 57.7 57.7 57.7 71 71.2 71.1 72 72.1 72.05
7 67.7 52.9 52.8 52.85 60.2 60.1 60.15 64 64 64 70.4 70.3 70.35
8 73.4 56.3 56.2 56.25 69.4 69.3 69.35 66.4 66.3 66.35 83 83 83
9 64.3 59.6 59.2 59.4 61.6 61.3 61.45 53.4 53.3 53.35 66.2 66.1 66.15
10 61.2 54.2 54.1 54.15 54.2 54.1 54.15 60.2 60.1 60.15 68.2 68.1 68.15
11 65.2 59.4 59.2 59.3 47.6 47.5 47.55 65.4 65.3 65.35 68.7 68.5 68.6
12 68.6 62.5 62.3 62.4 62.8 62.3 62.55 64.9 64.8 64.85 75 75 75
13 72.5 61.9 61.8 61.85 55.7 55.7 55.7 61.6 61.5 61.55 76.9 76.8 76.85
14 64.2 69.9 69.8 69.85 66 66 66 67 67 67 69.9 69.8 69.85
15 70.7 66.2 66.1 66.15 63.5 63.3 63.4 70.7 70.3 70.5 77.3 77.2 77.25
16 60.1 59.9 59.3 59.6 60.1 60 60.05 59.6 59.5 59.55 68.3 68.2 68.25
17 57.3 66 66.1 66.05 63.9 63.7 63.8 60.2 60.1 60.15 69.9 69.9 69.9
18 61.6 64.7 64.3 64.5 60.6 60.5 60.55 61.6 61.3 61.45 68 68 68
19 70.8 60.9 60.8 60.85 61 61.1 61.05 70.8 70.5 70.65 70.8 70.2 70.5
20 66.1 57.1 57.2 57.15 53.6 53.7 53.65 61.6 61.5 61.55 65.8 65.3 65.55
21 70.9 66.1 66.3 66.2 54.9 54.8 54.85 62.6 62.5 62.55 67.4 67.3 67.35
22 62.9 63.2 63.1 63.15 60 60.1 60.05 62.1 62.1 62.1 67.6 67.3 67.45
23 65.3 64 64.5 64.25 56.7 56.3 56.5 59.4 59.3 59.35 70.7 70.7 70.7
24 57.3 59 59.3 59.15 57.9 57.8 57.85 62.2 62.1 62.15 70.1 70.2 70.15
25 58.9 58.8 58.8 58.8 51.3 51.2 51.25 58.9 58.5 58.7 70.9 70.8 70.85
26 66.7 57.2 57.3 57.25 56.6 56.3 56.45 59.4 59.3 59.35 69.9 69.9 69.9
27 61.7 59.2 59.3 59.25 55.8 55.3 55.55 58.8 58.7 58.75 69.6 69.6 69.6
28 38.5 65.5 65.3 65.4 58.6 58.3 58.45 56.8 56.7 56.75 72.7 73.7 73.2
29 59.4 58.5 58.1 58.3 44.3 44.3 44.3 55 55 55 67.8 67.7 67.75
30 54.8 58 58.3 58.15 54.6 54.7 54.65 63.2 63.1 63.15 66.7 66.6 66.65
31 60.6 64.4 64.3 64.35 53.6 53.7 53.65 56 56 56 77.1 77.2 77.15
32 50.6 56.1 56.2 56.15 47.7 47.7 47.7 59.3 59.2 59.25 70 70 70
33 50.4 62.7 62.3 62.5 50.1 50.2 50.15 60.2 60.1 60.15 74.5 74.3 74.4
34 54.2 51.9 51.3 51.6 51.9 51.8 51.85 66.4 66.3 66.35 77.3 77.2 77.25
35 56.7 55.8 55.7 55.75 53 53 53 67.1 67.1 67.1 79.3 79.2 79.25
MASTER TABLE-FEMALE SAMPLES

49
[Link]. Occlusal Thumb length [A] Corner of mouth to Lateral border of the
Vertical Tip of thumb to tip of centre of pupil of eye outer canthus (eye) to
Dimension the index finger length [C] the tragus of the ear
(Z) (in [B] [D]
mm)

Right Left Average Right Left Average Right Left Average Right Left Average

50
 36 53.7 60.5 60.5 60.5 54.3 54.2 54.25 56.3 56.2 56.25 72.2 72 72.1
37 56.2 63.4 63.3 63.35 51.8 51.7 51.75 55.7 55.8 55.75 71.2 71 71.1
38 54 58.4 58.3 58.35 50.3 50.2 50.25 60.2 60.1 60.15 72.9 72.8 72.85
39 59.4 54 54.2 54.1 58.1 58.2 58.15 55 55 55 67.8 67.7 67.75
40 57.7 65.8 65.3 65.55 64.5 64.3 64.4 57.7 57.3 57.5 70.7 70.6 70.65
41 54.8 67.3 67.3 67.3 46.2 40.3 43.25 61.2 61.3 61.25 70.5 70.3 70.4
42 65 59.5 59.7 59.6 61.4 61.3 61.35 59.8 59.7 59.75 64.5 64.3 64.4
43 54.3 61.8 61.7 61.75 54.2 54.1 54.15 59.9 59.8 59.85 75 75 75
44 61.1 65.4 65.3 65.35 57.3 57.2 57.25 64.3 64.2 64.25 71.4 71.3 71.35
45 66.1 65.2 65.3 65.25 45.1 45.1 45.1 68.2 68.1 68.15 75.3 75.2 75.25
46 54.1 66.2 66.6 66.4 57.1 57.2 57.15 59.4 59.4 59.4 70.3 70.2 70.25
47 62.3 59.4 59.5 59.45 55.3 55.2 55.25 57.4 57.4 57.4 71.5 71.3 71.4
48 55.7 55.8 55.7 55.75 63.4 63.3 63.35 69 69 69 72.9 72.8 72.85
49 57.2 68.2 68.3 68.25 52.8 52.7 52.75 54.7 54.3 54.5 74.7 74.3 74.5
50 60.6 62.1 62.2 62.15 53.6 53.3 53.45 56 56 56 77.1 77.2 77.15
51 50.6 52.1 52.2 52.15 47.7 47.7 47.7 59.1 59.2 59.15 68 68 68
52 50.4 62.1 62.2 62.15 50.1 50.1 50.1 60.2 60.1 60.15 74.5 74.5 74.5
53 65.2 64 64 64 56 56 56 59.4 59.4 59.4 70.7 70.7 70.7
54 61.7 59.1 59.1 59.1 54 54 54 58.8 58.8 58.8 69 69 69
55 68 65.2 65.1 65.15 61.2 61 61.1 65.2 65.1 65.15 75 75 75
56 54.5 56.9 56.3 56.6 62.3 62.1 62.2 62 62 62 70.5 70.6 70.55
57 67.7 52.9 52.8 52.85 60.2 60.2 60.2 64 64 64 70.4 70.5 70.45
58 58.6 62.5 62.1 62.3 62.8 62.7 62.75 64.9 65 64.95 75 75 75
59 70.9 66 66.1 66.05 54.5 54.3 54.4 62 62 62 62.9 63 62.95
60 58.9 58.8 58.7 58.75 51.3 51.2 51.25 53 53.1 53.05 69.2 69.2 69.2
61 59.5 60.7 60.3 60.5 54.6 54.3 54.45 68.6 68.5 68.55 68.4 68.4 68.4
62 70.8 70.4 70.3 70.35 75.8 75.7 75.75 69.6 69.5 69.55 78.4 78.5 78.45
63 65 59.5 59.3 59.4 63.4 63.4 63.4 59.8 59.9 59.85 75 75 75
64 54.1 66.2 66.1 66.15 57.1 57.2 57.15 59.4 59.4 59.4 70.3 70.3 70.3
65 57.2 68.2 68.1 68.15 52.8 52.7 52.75 60 60 60 74.1 74 74.05
66 50.6 54.1 54.2 54.15 48.7 48.7 48.7 59.1 59.2 59.15 68 68 68
67 68 55.6 55.3 55.45 62.4 62.4 62.4 60 60.1 60.05 81.2 81.3 81.25
68 57 62.3 62.2 62.25 56.9 56.8 56.85 70.5 70.4 70.45 72.2 72.3 72.25
69 70.9 66.1 66.1 66.1 65.9 66 65.95 62.6 62.6 62.6 67.4 67.5 67.45
70 54.8 58 58 58 54.6 54.6 54.6 63.9 63.9 63.9 66.9 67 66.95

[Link]. Occlusal Thumb length [A] Tip of thumb to tip of Corner of mouth to
Lateral border of the
Vertical the index finger length centre of pupil of eye
outer canthus (eye) to
Dimension(Z) [B] [C] the tragus of the ear
(in mm) [D]
Right Left Average Right Left Average Right Left Average Right Left Average
71 50.2 67.7 67.3 67.5 51.3 51.3 51.3 66.4 66.3 66.35 77.3 77.3 77.3
72 57.7 65.8 65.3 65.55 64.5 64.6 64.55 57.7 57.6 57.65 70.7 70.8 70.75
73 54.1 60.2 60.1 60.15 56.2 56.2 56.2 63 63 63 67.8 67.8 67.8

51
 74 59.2 63 63 63 58.2 58.3 58.25 67 67 67 69.2 69.3 69.25
75 61.2 65 65 65 63 62.9 62.95 69 69.1 69.05 70.2 70.3 70.25
76 49.2 55 55 55 52.1 52.1 52.1 59 58.1 58.55 63.2 63.2 63.2
77 62 58 58.1 58.05 56 56 56 60.3 60.2 60.25 69.4 69.5 69.45
78 59.2 63 63.1 63.05 61.2 61.1 61.15 66.9 66.8 66.85 70.1 70.2 70.15
79 63.1 67 67.2 67.1 62.2 65 63.6 69 69 69 72 72 72
80 54.2 60.1 60 60.05 56.1 56 56.05 68.2 68.1 68.15 70 70 70
81 68.1 66.2 66.1 66.15 61.2 61.1 61.15 65.2 65.2 65.2 75 75 75
82 57.4 60.1 60 60.05 56.9 57 56.95 70.4 70.3 70.35 72.2 72.3 72.25
83 50.1 56 56.1 56.05 48.7 48.8 48.75 58 58 58 69.1 69 69.05
84 57 62.3 62.2 62.25 56.9 57 56.95 70.5 70.4 70.45 72.2 72 72.1
85 59 65.8 65.7 65.75 64.2 64.1 64.15 57.7 57.7 57.7 70.7 70.8 70.75
86 67 52 52 52 60.2 60.1 60.15 64 64 64 70.7 70.7 70.7
87 57.3 59 59 59 57.9 57.9 57.9 62.2 62.2 62.2 72.2 72.2 72.2
88 62.9 66.1 66 66.05 60.1 60 60.05 59 59 59 68.2 68.3 68.25
89 50.2 52.1 52 52.05 49 49 49 64 64 64 66.2 66.2 66.2
90 61.9 65 65 65 59.2 59.1 59.15 59 59.1 59.05 63.2 63.3 63.25
91 49 55 55 55 51.4 51.4 51.4 63 63 63 66 66 66
92 54.7 58 58 58 54.9 54.9 54.9 60 60.1 60.05 65.9 66 65.95
93 56.2 58 58.2 58.1 51.2 51.2 51.2 69 68.9 68.95 73.2 73.2 73.2
94 60.1 65 65.1 65.05 62.2 62.1 62.15 68 68 68 70.2 70 70.1
95 58.2 62.2 62.1 62.15 60.1 60 60.05 68 68.1 68.05 69.2 69.2 69.2
96 50 62 62 62 54.2 54.2 54.2 65 65 65 68.5 68.5 68.5
97 48.2 52.2 52 52.1 51 51.1 51.05 63.1 63 63.05 69 69.1 69.05
98 54.2 56.2 56 56.1 52 52 52 65.1 65.2 65.15 68 68 68
99 59.2 55 55 55 57.2 57.1 57.15 58 58 58 69.2 69.3 69.25
100 50.2 56 56 56 49 49 49 56 56.1 56.05 68 68 68

52