Journal of Oral Rehabilitation 2006 33; 102–109
Influence of lip support on the soft-tissue profile of complete
denture wearers
Y. KAMASHITA*, Y. KAMADA* N. KAWAHATA† & E. NAGAOKA‡
Maxillofacial Prosthodontics, Field of Oral and Maxillofacial Rehabilitation, Course for Advanced Therapeutics, Kagoshima University
Graduate School of Medical and Dental Sciences, Kagoshima, Japan, †Dentist in private practice, Tenri, Japan and ‡Department of Oral and
Maxillofacial Prosthodontics, Field of Oral and Maxillofacial Rehabilitation, Course for Advanced Therapeutics, Kagoshima University
Graduate School of Medical and Dental Sciences, Kagoshima, Japan
SUMMARY Complete dentures change the soft-tissue
profile, although the exact relationship remains
unclear. This study examined the relationship
between the presence and degree of lip support
provided by dentures and the lateral views of the
facial appearance of edentulous patients. The sub-
jects were five edentulous patients (three men and
two women). Their facial appearances with
experimental record blocks, with and without their
complete dentures, were measured using a three-
dimensional laser measuring system. The experimen-
tal record block for each subject had different
conditions in the anteroposterior direction anteriorly
but the same vertical dimensions posteriorly. The
lateral digital facial images were displayed on a
computer monitor, and the linear and angular
Introduction
The lower one-third of the face has a major impact on
facial appearance (1, 2). The facial appearance of an
edentulous person changes with the loss of lip support
and intercuspal position following tooth extractions,
but can be restored by complete dentures (3, 4), which
provide lip support and an occlusal vertical dimension.
For denture wearers to retain a natural appearance, it is
important to provide adequate lip support and an
appropriate occlusal vertical dimension.
Several previous studies have reported on the facial
appearance of edentulous patients. These studies com-
pared dentate and edentate subjects (5, 6), the differ-
ence between with and without dentures (7), the
ª 2006 Blackwell Publishing Ltd
*Department of Oral and
measurements were analysed using image analysis
software. The nasolabial angle was smaller and the
labial points projected more with excessive lip sup-
port versus with deficient support. Moreover, the
counter of the nose was affected by the labial flange of
the record base, particularly in the facial appearance
of one subject with highly atrophic residual ridges.
The lip support affected the lower facial soft-tissue
profile, including the lower part of the nose; the
nasolabial angle and positional relationship between
the lips and Ricketts’s esthetic plane (E plane) are
useful indexes for examining lip support.
KEYWORDS: facial appearance, lip support, complete
denture, profile, esthetic plane
Accepted for publication 10 September 2005
temporal changes over the period of wearing dentures
(8, 9), or the differences among old, reconstructed and
new dentures (10). Using photographs (7), lateral
radiograms (5, 6, 8, 9), traced 35-mm slide projections
(10) and digital camera images (11), these previous
studies demonstrated that soft-tissue profile analysis is
useful for researching the facial appearance of denture
patients and is convenient for daily prosthodontic
treatment.
The soft-tissue profile is affected by the lip support,
which is altered by the anterior artificial dental arch
and denture flange (12), but the exact relationship
between the facial profile and this altered lip support
remains unclear. Therefore, we evaluated the influ-
ence of the presence and degree of lip support by
102
 INFLUENCE OF LIP SUPPORT ON EDENTATE PROFILE
dentures on the lateral views of the faces of edentu-
lous patients.
Material and methods
Subjects
The subjects were five edentulous Japanese volunteers
(three men and two women) who were treated with
upper and lower complete dentures at Kagoshima
University Dental Hospital. The study was explained
and informed consent was obtained. No subjects had
any abnormal morphological or functional findings.
The subjects had a mean age of 65Æ8 years (range 54–
78).
Conditions of lip support
To evaluate the effect of wearing complete dentures on
the lip support, the soft-tissue profile with and without
dentures was investigated. The facial appearances of the
subjects were measured in the intercuspal position with
their dentures [D(+)] and in the rest position without
them [D())]. Their dentures were fabricated by experi-
enced dentists following standard procedures.
Various states of lip support restored by wearing
dentures were simulated using experimental record
blocks. The experimental record block (Fig. 1), which
consists of a cold-cured resin record base and an acrylic
occlusion rim, could be divided into a removable
anterior part and a fixed posterior part. The posterior
part of the occlusion rim was kept constant under the
maxillo–mandibular relationship, determined while
wearing dentures. The anterior part could be adjusted
to give five conditions of lip support: (1) R(0) (standard
d
a
b
c
e horizontal on the lateral view. The images of each
Fig. 1. Schematic of the experimental record blocks. (a) R()5),
(b) R(0), (c) R(+5), (d) R())B(+), (e) R())B()).
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 102–109
103
Non-contact type
three dimensional 3D Measurement
measuring system
(Voxelan)
3D Facial image
Image processing
Correcting
system
(3D-Sphinx)
head posture
Lateral view
Analyzing system
Calculating angular
and linear items
Fig. 2. Schematic of the diagnostic system.
lip support): incisal edge of occlusion rim (IEOR)
10 mm in front of the center of the incisive papilla
(13), (2) R(+5) (excessive lip support): IEOR 5 mm
anterior to R(0), (3) R()5) (deficient lip support): IEOR
5 mm posterior to R(0), (4) R())B(+) (lip supported by
the record base only): without the occlusion rim but
with the record base anteriorly, and (5) R())B()) (no
lip support): without both the occlusion rim and the
record base anteriorly.
Measurement system
In this study, the facial appearances of the subjects were
measured using the three-dimensional (3D) laser meas-
uring system (Fig. 2) reported by Nishi et al. (14),
because this system improves the accuracy of the
analysis by correcting head posture in three dimen-
sions. Adjusted lateral views of each subject were
obtained after fitting the facial images in three dimen-
sions.
Three-dimensional facial images obtained using a 3D
laser measuring apparatus* with an accuracy of 0Æ5 mm
were reconstructed using an imaging system†. When
the head posture for the measurement was incorrect,
the 3D image was rotated so that the sagittal plane was
vertical on the frontal view and the Frankfort plane was
subject were matched in three dimensions by aligning
the upper face, which was not affected by the dentures.
*Voxelan; NKExa, Japan
†
3D-Sphinx; Medic Engineering, Japan
104 Y . K A M A S H I T A et al.

The 3D images were projected on the sagittal plane. In Angular measurement

the lateral view of the facial image displayed on a Symbols of measurements

1. Nasolabial angle
computer monitor, the 2D coordinate data of landmarks
2. ls-ch-sto
1 2
were obtained by clicking the mouse button using 3. li-ch-sto
3 4 4. ls-ch-li
image-processing software†. The linear and angular 5. lst - E
measurements were calculated using the original ana- 6. lit - E
Linear measurement 7. prn - I
lysis software. 8. sn - I
9. lst - I
10. lit - I
13 11. labm - I
Landmarks and measured items 7
5 12. pg - I
6 8
9 13. ex - ch
The landmarks (Fig. 3) and measured items (Fig. 4) on 11
10 14 14. sn - pg
15. sn-pg / ex-ch
12
the lateral view in this study were the same as those in
our previous study (11, 15). These items were deter-
mined to evaluate lip support and the occlusal vertical Esthetic plane Izard plane
(E plane) (I plane)
dimension in prosthodontic treatment. The definitions
of the landmarks followed Martin et al. (16). We used Fig. 4. Items measured in the lateral view.
four additional points: cms, cmi, lss and lsi (Figure 3
and Table 1). The data consisted of four angular
measurements and 11 linear measurements. Each item The vertical linear measurements, upper facial height
is named by hyphenating the symbols of the corres- (ex-ch), lower facial height (sn-pg) and their ratio
ponding landmarks. (sn-pg/ex-ch), were used to evaluate the vertical
Ricketts’s aesthetic plane (E plane; 17) and the Izard dimension of occlusion.
plane (I plane; 18) were used as reference planes for the
horizontal linear measurements. When the landmarks
Statistical analysis
were posterior to the reference planes, the measured
values were negative. The I plane is the vertical plane The paired t-test was used to evaluate the differences
through the glabella. A change in these measurements between the mean values of measurements with and
reveals a shift of the respective landmark in the without dentures. One-way repeated measures analysis
anteroposterior direction. of variance (ANOVA) and Tukey–Kramer multiple com-
parison tests were used to evaluate the data on the
facial appearances of subjects wearing the experimental
1. g record block under different conditions. The signifi-
1 2. prn cance level for all statistical comparisons was set at
3. cms P < 0Æ05.
4. cmi
15
5. sn
6. lss Results
7. lsi
8. ls Effect of wearing complete dentures
2 9. lst Table 2 shows the mean values and standard deviations
3 10. sto
5 4 of the measurements and the results of the statistical
6 11. lit
7 8 analysis of the facial profiles with [D(+)] and without
9 12. li
16 10 [D())]dentures.
11 13. labm
The mean nasolabial angle for D(+) (102Æ5
) was
12 14. pg
significantly smaller than that for D()) (120Æ2
; paired
13 15. ex
14 t-test, P ¼ 0Æ034). The mean value of ls-ch-li for D(+)
16. ch
(39Æ4
) was significantly larger than that for D())
(26Æ7
). The mean value of lst-E for D(+) ()3Æ0 mm)
Fig. 3. Reference points in the lateral view. was significantly different from that for D())

ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 102–109

 INFLUENCE OF LIP SUPPORT ON EDENTATE PROFILE 105

Table 1. Definitions of the reference

Reference points Definition
points
g (glabella) The anterior-most point of the forehead
prn (pronasale) The anterior-most point of the nose
cms The upper end of the linear part of the columella
cmi The lower end of the linear part of the columella
sn (subnasale) The turning point between the columella and the upper lip
lss The superior point of the straight line under the nose
lsi The inferior point of the straight line under the nose
ls (labrale superior) The superior-most point of the upper vermillion
lst The anterior-most point of the upper vermillion
sto (stomion) The meeting point of the upper and lower vermilions
lit The anterior-most point of the lower vermilion
li (labrale inferius) The inferior-most point of the lower vermillion
labm (labiomentale) The deepest point of the concavity of the lower lip
pg (pogonion) The anterior point on the symphisis of the chin
ex (ectocanthion) The posterior-most point of the eye
ch (cheilion) The commissure of the mouth

Table 2. Mean and standard deviations of each measurement the nasolabial angles. Repeated measures ANOVA for the
with and without dentures and the results of the paired t-test nasolabial angle and horizontal linear measurements
revealed significant differences among the experimen-
D(+) D())
Paired t-test tal conditions, except for prn-I and pg-I.
Mean s.d. Mean s.d. P-value R(+5) had a significantly smaller nasolabial angle
(96Æ0
) than did R()5), R())B(+) and R())B()) (114Æ4,
Nasolabial angle (
) 102Æ5 6Æ82 120Æ2 12Æ67 0Æ034*
ls-ch-sto (
) 18Æ8 4Æ87 10Æ8 6Æ29 0Æ055 114Æ8 and 119Æ6
respectively). The mean value of lst-E
li-ch-sto(
) 20Æ6 5Æ91 15Æ8 5Æ09 0Æ083 for R(0) ()3Æ8 mm) was significantly smaller than that
ls-ch-li (
) 39Æ4 5Æ62 26Æ7 9Æ88 0Æ034* for R(+5) ()0Æ9 mm) and was significantly larger than
lst-E (mm) )3Æ0 1Æ99 )10Æ7 5Æ55 0Æ027* those for R())B(+) ()9Æ7 mm) and R())B())
lit-E (mm) )1Æ4 1Æ83 )8Æ7 6Æ48 0Æ077
()9Æ9 mm). There was a significant difference in lit-E
prn-I (mm) 14Æ7 3Æ46 13Æ2 2Æ90 0Æ096
sn-I (mm) 0Æ6 2Æ31 )4Æ1 3Æ69 0Æ048* between R(+5) and R()5) (2Æ0 and )2Æ9 mm respect-
lst-I (mm) 2Æ3 2Æ85 )7Æ2 6Æ04 0Æ034* ively). The values for R(+5), R(0) and R()5) differed
lit-I (mm) 0Æ2 3Æ23 )7Æ8 5Æ98 0Æ065 significantly from those for R())B(+) ()7Æ2 mm) and
labm-I (mm) )5Æ5 3Æ17 )10Æ9 4Æ79 0Æ090 R())B()) ()6Æ6 mm).
pg-I (mm) )4Æ5 4Æ18 )7Æ2 4Æ35 0Æ173
Concerning sn-I, there was a significant difference
ex-ch (mm) 65Æ9 1Æ20 66Æ9 2Æ61 0Æ207
only between R(+5) (1Æ6 mm) and R())B())
sn-pg (mm) 48Æ5 4Æ04 47Æ9 5Æ55 0Æ706
sn-pg/ex-ch 0Æ74 0Æ06 0Æ72 0Æ09 0Æ587 ()2Æ2 mm). The mean values of lst-I and lit-I for
R(+5) differed significantly from those for the other
*Significant difference (P < 0Æ05)
conditions. R())B(+) and R())B()) were significantly
smaller than the other conditions. The mean value of
()10Æ7 mm). The mean values of sn-I and lst-I for D(+) labm-I for R(+5) ()2Æ5 mm) differed significantly from
(0Æ6 and 2Æ3 mm respectively) differed significantly those for R())B(+) and R())B()) ()7Æ3 and )6Æ9 mm
from those for D()) ()4Æ1 and )7Æ2 mm respectively). respectively), but did not differ from those for R(0) and
R()5) ()5Æ1 and )4Æ8 mm). The vertical linear meas-
urements were similar to each other, and there were no
Influence of the experimental record blocks
significant differences among the experimental condi-
The results for the facial profiles with the experimental tions.
record blocks are shown in Table 3. The more protru- The measurements of items for R(0) were similar to
sive the occlusion rims were, the larger were the the respective items for D(+). All the horizontal meas-
horizontal linear measurements and the smaller were urements for R())B()) were smaller than those for

ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 102–109

106 Y . K A M A S H I T A et al.

Table 3. Mean and standard deviations of the measurements and the results of repeated measures ANOVA

R())B()) R())B(+) R()5) R(0) R(+5) ANOVA P-value

Nasolabial angle (
) 119Æ6 (14. 30)a 114Æ8 (8Æ56)a 114Æ4 (7Æ85)a 107Æ1 (8Æ39)a,b 96Æ0 (7Æ02)b 0Æ004 *
ls-ch-sto (
) 13Æ8 (5Æ59) 14Æ5 (3Æ91) 13Æ7 (2Æ30) 16Æ4 (2Æ44) 15Æ6 (5Æ40) 0Æ720
li-ch-sto (
) 17Æ8 (12Æ62) 16Æ9 (8Æ57) 18Æ0 (4Æ33) 19Æ3 (7Æ59) 25Æ1 (3Æ69) 0Æ144
ls-ch-li (
) 31Æ7 (16Æ49) 31Æ3 (8Æ71) 31Æ7 (4Æ19) 35Æ8 (7Æ40) 40Æ8 (5Æ21) 0Æ277
lst-E (mm) )9Æ9 (1Æ87)a )9Æ7 (2Æ64)a )5Æ7 (1Æ13)b )3Æ8 (1Æ83)b )0Æ9 (1Æ58)c <0Æ001*
lit-E (mm) )6Æ6 (2Æ88)a )7Æ2 (2Æ64)a )2Æ9 (1Æ22)b )0Æ7 (1Æ33)b,c 2Æ0 (1Æ98)c <0Æ001*
prn-I (mm) 14Æ2 (2Æ79) 14Æ2 (3Æ48) 14Æ6 (3Æ24) 14Æ3 (3Æ14) 14Æ9 (3Æ29) 0Æ284
sn-I (mm) )2Æ2 (1Æ70)a )1Æ7 (2Æ63)a,b 0Æ2 (1Æ91)a,b 0Æ3 (2Æ12)a,b 1Æ6 (2Æ95)b 0Æ031*
lst-I (mm) )4Æ6 (1Æ69)a )4Æ5 (2Æ67)a )0Æ1 (2Æ59)b 1Æ7 (2Æ38)b 6Æ0 (3Æ12)c <0Æ001*
lit-I (mm) )4Æ2 (1Æ54)a )4Æ6 (2Æ34)a )0Æ6 (2Æ63)b 0Æ7 (2Æ63)b 5Æ2 (4Æ12)c <0Æ001*
labm-I (mm) )6Æ9 (2Æ23)a )7Æ3 (2Æ88)a )4Æ8 (3Æ26)a,b )5Æ1 (2Æ76)a,b )2Æ5 (3Æ87)b 0Æ002*
pg-I (mm) )4Æ2 (3Æ49) )4Æ1 (4Æ45) )3Æ3 (4Æ31) )4Æ1 (2Æ94) )1Æ9 (4Æ61) 0Æ128
ex-ch (mm) 67Æ4 (3Æ43) 66Æ4 (0Æ95) 66Æ0 (1Æ20) 67Æ2(1Æ36) 66Æ9 (2Æ94) 0Æ531
sn-pg (mm) 46Æ8 (6Æ40) 47Æ3 (6Æ25) 46Æ2 (5Æ57) 47Æ5 (4Æ97) 47Æ4 (3Æ83) 0Æ680
sn-pg/ex-ch 0Æ70 (0Æ11) 0Æ71 (0Æ10) 0Æ70 (0Æ09) 0Æ71 (0Æ07) 0Æ71 (0Æ07) 0Æ754

* Significant difference (P < 0Æ05), mean values with the same superscript letters did not differ significantly (P > 0Æ05) in the post hoc test.
Values are expressed as mean (s.d.).

D()). The angular measurements of the vermilions for g

R())B()) were larger than those for D()), while the
nasolabial angles were similar.
n
(mm)
Profilogram of one subject with a highly atrophic residual
ridge

A profilogram was made to examine the change in the

profile of one subject whose jaws, particularly the upper
jaw, had a highly atrophic residual ridge (Fig. 5). A
prn
profilogram is a figure (g-n-prn-sn-ls-sto-li-labm-pg)
that connects the eight landmarks (g, prn, sn, ls, sto, li,
labm and pg) and the nasion (n) with a line. The sn
coordinate data for the nasion, which was used as the
origin for the profilogram, were obtained in the same ls
way as for the other landmarks. The nasion is sometimes sto
hidden by the eyelid on the lateral view in Japanese. In
li
such cases, we obtained the 2D coordinate data on the
mid-sagittal cross-section from 3D coordinate data. The labm
seven figures made under the different experimental pg
conditions were superimposed using the nasion.
All landmarks, except the glabella, shifted antero-
posteriorly and inferosuperiorly according to the lip Fig. 5. The profilograms of one patient with the experimental
record blocks, with and without dentures. The nasion was used as
support condition: D()) was the most posterior and
the origin and each line connects eight landmarks (g-n-prn-sn-ls-
R(+5) was the most anterior. The profilograms for D(+), sto-li-labm-pg).
R()5) and R(0) were similar. The profilograms for
R())B()) and R())B(+) were very similar, but sn for
R())B(+) was anterosuperior to R())B()). The posi- R()5), R(0), R(+5) and R())B(+) were similar, while
tions of ls, sto, li and labm for D()) were posterior to the position for D()) was posterior and that for
R())B()) and R())B(+). The positions of prn for D(+), R())B()) was intermediate.

ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 102–109

 INFLUENCE OF LIP SUPPORT ON EDENTATE PROFILE
Discussion
Three-dimensional approaches, such as volume analysis
or surface data observations using cross sectional views
in any plane, are important, and in another study we
are investigating 3D facial analysis of denture wearers.
However, the 3D apparatus is too expensive for use in a
general practitioner’s clinic. In this study, we focused
on profile analysis because soft-tissue profile analysis is
very useful and convenient for assessing the facial
appearance of complete denture patients before and
after treatment. We used a 3D measurement system in
this study to allow correction of head posture in three
dimensions in order to ensure that facial images with
different experimental dentures coincided.
We have reported a facial analysis system that uses a
digital camera and the same measurement items used in
this study (11, 15, 19). In one of our reports (19), we
compared young–adult (ages 23–29) and young–old
(ages 51–78) Japanese dentate subjects. The mean
values of the young–old group were used to discuss
the results in this study.
Portion affected by the lip support conditions
The major differences in the linear measurements
concerning the vermilions (lst-I, lit-I, lst-E and lit-E)
and nasolabial angle between those subjects with and
without dentures and between the different conditions
of the experimental record blocks indicate the change
in the upper and lower lip contours. The significant
differences in sn-I and labm-I for the different experi-
mental conditions mean that the degree of lip support
changes not only the lip contour but also the form of
the nasal base and labiomental sulcus. These results are
in agreement with Fanibunda et al. (7), who reported a
forward shift of the upper and lower lips following the
insertion of complete dentures and the dominant effect
of maxillary dentures.
The profilogram for the subject with marked bone
resorption reached the anterior nasal spine (Fig. 5),
indicating that the lip support altered the form of the
lower half of the nose, including its tip. These results
mean that a denture can change the form of the nose.
Measurement items affected by denture conditions
Nasolabial angle The nasolabial angle is a common
parameter for evaluating the facial profiles of complete
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 102–109
107
denture wearers. Watt and MacGregor (13) stated that
the nasolabial angle for adequate lip support is approxi-
mately 90
in fabricating complete dentures. Brunton
and McCord (5) have reported that the nasolabial angle
of Caucasian dentate subjects is approximately 110
and
that edentulous patient should be given an obtuse
nasolabial angle exceeding 90
as a prosthodontic
guideline. Owen et al. (20) reported racial differences
for the nasolabial angle in the facial appearances of
dentate subjects, ranging in age from 18 to 41 years
(mean age 26Æ5), from six racial groups, including
Japanese. Japanese had a smaller nasolabial angle
(97Æ1
) than did Caucasians (109Æ5
) and Hispanics
(105Æ1
), but a larger angle than did Koreans (92Æ9
),
Chinese (92Æ5
) and African Americans (90Æ0
).
The mean nasolabial angle for D(+) (102Æ5
), which
was significantly smaller than that for D()) (120Æ2
),
was similar to that reported by Owen et al. (20) for
young–adult groups (97Æ1
) and by Kamashita et al. (19)
for young–old groups (105Æ5
in males and 93Æ1
in
females) of dentate Japanese. This suggests that the
recovery of lip support with dentures could reduce the
larger nasolabial angle that results from the loss of lip
support owing to missing teeth to the level of that in
dentate groups.
The nasolabial angle for R(+5) (96Æ0
) was signifi-
cantly smaller than that for the other conditions, except
R(0) (107Æ1
). Therefore, the nasolabial angle is altered
by the lip support provided by the anterior teeth,
especially excessive lip support by protrusive anterior
teeth. The nasolabial angle for D()) was very near that
for R())B()), and that for D(+) was most similar to that
for R(0). Therefore, the nasolabial angle is a useful
parameter of lip support.
Angular measurements of the vermilion It has been repor-
ted that poor lip support reduces the height of the
vermilion (12). Three angular measurements (ls-ch-sto,
li-ch-sto and ls-ch-li) used to evaluate the upper and
lower vermilions were affected by vermilion height and
the position of the cheilion. These measurements
increased with denture insertion, and the mean ls-ch-li
was significantly larger for D(+) (39Æ4
) than for D())
(26Æ7
), but was smaller than that for young–old
dentate Japanese (48Æ6
in males, 59Æ5
in females) as
reported by Kamashita et al. (19). These results sugges-
ted that the vermilions, which rotated in the inner oral
cavity with the loss of lip support from the teeth, were
pushed out and enlarged by the insertion of the
108 Y . K A M A S H I T A et al.
dentures. However, the degree of vermilion height
recovered was smaller than that in the young–old (ages
65–74) dentate groups. This may be owing to the
atrophy of the vermilions caused by aging and the loss
of teeth.
Horizontal measurements referring to the I plane The trends
of the changes in lst-I and lit-I with the experimental
conditions were the same as those in lst-E and lit-E,
except in lit-I for R(+5). The shifts in the positions of in
and lit (1Æ8 and 1Æ3 mm respectively) from R()5) to
R(0) were smaller than those from R(0) to R(+5) (4Æ3
and 4Æ5 mm, respectively). The former small shift
compared with the latter, which was similar to the
anterior arch shift (5 mm), and this probably arose from
the difference between slack and stretched soft tissues,
as well as the lip position relative to the E plane, as
mentioned below.
The larger horizontal measurements obtained for
R())B()) compared with those for D()), which mean
that positions lst and lit for R())B()) are anterior to
those for D()), suggest that the presence of posterior
teeth contributes to lip support.
The similarity in the measurements of the corres-
ponding items for R(0) and D(+) showed the validity of
positioning the labial surface of the occlusion rim
10 mm forward from the center of the incisive papilla.
Horizontal lip position referring to the E plane The upper
and lower lip positions relative to Ricketts’s E plane
(17) are major parameters reflecting the harmony of
the facial profile. Ricketts reported that for Caucasians,
the upper and lower lips should lay 4 and 2 mm
posterior to the E plane respectively (17). Owen et al.
(20) reported racial differences for the upper and lower
lip positions relative to the E plane. The upper and
lower lip positions relative to the E plane for Japanese
()1Æ9 and )1Æ2 mm) were posterior to those for African
Americans (0Æ3 and 2Æ9 mm) and anterior to those for
Caucasians ()7Æ5 and )5Æ2 mm).
The measurements involving the E plane, lst-E
()10Æ7 and )3Æ0 mm) and lit-E ()8Æ7 and )1Æ4 mm)
for D()) and D(+), indicated that the upper and lower
lip positions relative to the E plane shifted forward (7Æ7
and 7Æ3 mm respectively) on wearing complete den-
tures. However, D(+) ()3Æ0 mm) had a smaller lst-E
than that in the young–old dentate Japanese reported
by Kamashita et al. (19) ()0Æ5 mm in males and 0Æ6 mm
in females) and in young–adult dentate Japanese of
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 102–109
both sexes reported by Owen et al. (20) ()1Æ9 mm).
Conversely, the result for lit-E for D(+) ()1Æ4 mm) was
similar to reported values ()1Æ9 mm in males and
0Æ8 mm in females reported by Kamashita et al. (19) and
)1Æ2 mm reported by Owen et al. (20)). These results
indicate that atrophy resulting from aging and the loss
of teeth could be greater in the upper vermilion than in
the lower.
There were no significant differences in the values of
lst-E and lit-E between R())B()) and R())B(+), but the
more protrusive the anterior arches were, the larger lst-
E and lit-E were. Therefore, these measurements
depend on the altered lip support, but not on the
presence of the labial flange in the absence of an
anterior artificial dental arch.
The shifts in positions lst and lit relative to the E
plane from R()5) to R(0) were 1Æ9 and 2Æ2 mm,
respectively, and those from R(0) to R(+5) were 2Æ9
and 2Æ7 mm respectively. These shifts were smaller than
those relative to the I plane, as mentioned above. These
differences occurred because the E plane itself changed
with the shift in the position of the pronasale and
pogonion. These measurements for D(+) were similar to
those for R(0), which indicates that the standard record
block gives lip support equivalent to that of adequate
dentures.
From these results, the positions of lst and lit relative
to the E plane were affected by the anteroposterior
position of the artificial dental arch when the posterior
artificial dental arch maintained the correct occlusal
vertical dimension and supported the cheeks.
Maxillo–mandibular relationship The indexes of the ver-
tical dimension of occlusion (sn-pg, ex-ch and sn-pg/
ex-ch), and an index of the horizontal mandibular
positions (pg-I) did not differ significantly in the
different conditions. These results mean that the max-
illo–mandibular relationships and the vertical position
of the cheilion (ch) are not affected by the degree of lip
support when the mandibular positions are kept con-
stant.
Conclusion
The following conclusions can be drawn from the
results of this study:
1. The presence and condition of anterior artificial
dental arches affected not only the lip contour but also
the lower half of the nose.
 INFLUENCE OF LIP SUPPORT ON EDENTATE PROFILE
2. The nasolabial angle and lip position relative to the E
and I planes are useful indexes for examining lip
support in denture wearers.
3. The standard anterior occlusion rim (10 mm anterior
from the center of the incisive papilla) is useful for
fabricating dentures.
4. The presence of posterior teeth contributes to lip
support.
References
1. Terry RL, Davis JS. Components of facial attractiveness.
Percept Mot Skills. 1976;42:918.
2. Ray B, Nichola R. Social Psychology of Facial Appearance.
Springer Series in Social Psychology. New York, Springer
Verlag; 1988.
3. Willis FM. Esthetics of full denture construction. J Am Dent
Assoc. 1930;17:636–642.
4. Krajicek D. Guides for natural facial appearance as related to
complete denture construction. J Prosthet Dent. 1969;21:654–
662.
5. Brunton PA, McCord JF. An analysis of nasolabial angles and
their relevance to tooth position in the edentulous patient.
Eur J Prosthodont Restor Dent. 1993;2:53–56.
6. Watson RM, Bhatia SN. Tooth positions in the natural and
complete artificial dentitions, with special reference to the
incisor teeth: an interactive on-line computer analysis. J Oral
Rehabil. 1989;16:139–153.
7. Fanibunda KB, Allcock GC, Thomason JM. Changes in the
facial profile following insertion of complete dentures. Eur J
Prosthodont Restor Dent. 2002;10:143–149.
8. Ismail YH. Changes in soft-tissue profile following extraction
and complete denture treatment. J Prosthet Dent.
1971;26:11–20.
9. Tallgren A, Lang BR, Miller RL. Longitudinal study of soft-
tissue profile changes in patients receiving immediate com-
plete dentures. Int J Prosthodont. 1991;4:9–16.
10. Hamano T, Tsuru K, Kishita C, Kamashita Y, Nishi Y, Nagaoka
E. Improvement of face appearance of the edentulous patients
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 102–109
109
with the remarkable bone resorption in the maxillary anterior
ridge. A case report on the application of hydroxyapatite
granules. J Esthet Dent. 1997;9:309–316.
11. Kamashita Y, Onishi C, Kamada Y, Kawahata N, Nagaoka E.
Trial of facial appearance analysis using a digital camera.
Analyzing system and clinical application for denture wearers.
J Jpn Prosthodont Soc. 1999;43:602–613.
12. Boucher CO. Rehabilitation of the edentulous patient: fabri-
cation of complete dentures. In: Zarb GA, Bolender CL,
Carlsson GE, eds. Boucher’s prosthodontic treatment for
edentulous patients, 11th ed. St Louis: Mosby; 1997.
13. Watt DM, MacGregor AR. Designing complete dentures, 2nd
edn. Bristol, John Wright; 1986;3–47.
14. Nishi Y, Kamada Y, Kohno F, Kamashita Y, Kawahata N,
Nagaoka E. A diagnostic method of denture on image of face.
J Esthet Dent. 1995;8:73–78.
15. Kamashita Y, Kamada Y, Onishi C, Futamata Y, Kawahata N,
Nagaoka E. An analyzing system of esthetics on facial image
by digital camera. J Esthet Dent. 1998;11:207–209.
16. Hoshi H, Kawauti M, Etho M. I Somatometry. In: Etho M, ed.
Anthropology Additional. vol. 1, Anthropometry. Tokyo:
Yuzankaku; 1991:29–39.
17. Ricketts RM. Esthetics, environment, and the law of lip
relation. Am J Orthod. 1968;54:272–289.
18. Izard G. Orthopedie dento-faciale. Orthodontie. Paris, Mas-
son; 1930;456.
19. Kamashita Y, Onishi C, Kamada Y, Kawahata N, Nagaoka E.
Analysis of facial appearance using a digital camera. Compar-
ison between the young–adults dentulous group and young–
old dentulous group. J Esthet Dent. 1999;11:323–329.
20. Owens EG, Goodacre CJ, Loh PL, et al. A multicenter
interracial study of facial appearance. Part 1: a comparison
of extraoral parameters. Int J Prosthodont. 2002;15:273–282.
Correspondence: Yuji Kamashita, Department of Oral and Maxillofa-
cial Prosthodontics, Field of Oral and Maxillofacial Rehabilitation,
Course for Advanced Therapeutics, Kagoshima University Graduate
School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kago-
shima 890-8544, Japan.
E-mail: kamasita@dentb.hal.kagoshima-u.ac.jp