Considerations to Establish the Best Orientation of the Occlusal Plane Used in Oral Rehabilitation: A Systematic Review

Aim: The goal of this review was to compile all available information in an updated literature review to indicate the correct position of the tragus on Camper's plane and other considerations to establish the best orientation of the occlusal plane used in oral rehabilitation. Materials and methods: A comprehensive search was conducted by two trained reviewers across the primary data sources, including Medline via PubMed, ScienceDirect, Scopus, EBSCO, and SciELO. The search employed the keywords "(orientation) AND (dental occlusion OR occlusal plane OR Camper plane)" and covered the period from May 2018 to November 2025. The risk of bias for all selected articles was evaluated using the Newcastle-Ottawa Scale. The analysis focused on identifying the optimal orientation of the occlusal plane for use in oral rehabilitation. Results: A total of 1,710 articles were identified, of which only 14 were included for analysis. Seven articles had a low risk of bias. Moreover, these studies indicated that the ideal location for the posterior point of Camper's plane, when aligned with the tragus, results in an occlusal plane that runs parallel to it, connecting the lower border of the wing of the nose to the lower part of the tragus. This outcome remains consistent regardless of the patient's arch shape, clinical judgment, esthetics, or the stability of the restoration. Photography is considered the most widely used method for reconstructing the occlusal plane. Conclusion: The reviewed articles considered the most inferior point marked on the tragus, which would be the most appropriate for the occlusal plane in edentulous and dentate patients. Photography is the most widely used technique for determining the occlusal plane, as it is the most studied and used by clinicians. Clinical significance: Clinicians can accurately determine the occlusal plane in oral rehabilitation by locating the tragus in its optimal orientation using Camper's plane, which serves as the most stable reference for establishing the occlusal plane.