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Tooth Size Discrepancy among Different Malocclusion Groups in a Sudanese Sample

Authors:
Nosaiba Mahmoud at Mageet Orthdontic training centre
Nosaiba Mahmoud
  • Mageet Orthdontic training centre
Halah Eltahir
Halah Eltahir
Adil Osman Mageet at Mediclinic Middle East
Adil Osman Mageet
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Abstract Introduction: The standard model of orthodontic treatment can be divided into three different stages as stated by Proffit, namely leveling and alignment, working and finishing phases. Each of these presents different challenges. In particular the final, or “finishing” phase, constitutes the most complicated for the complexity of the various factors that need to be taken into account if an optimum result is to be achieved at the end of treatment. One of these factors, often a primary cause of difficulty, is Tooth Size Discrepancy (TSD). Problems arising from this can be alleviated if the existence of TSD forms part of the initial diagnosis and is considered when formulating a treatment plan for the individual patient. Objectives: The present research aimed at determining the extent and prevalence in a representative orthodontic population in Sudan and to investigate the dimensions of TSD in this population that comprised a clinically significant factor. Materials and methods: The sample comprised 107 pretreatment study casts with fully erupted and complete permanent dentitions from first molar to first molar, which were selected randomly from records of the orthodontic patients. The mesiodistal diameters of the teeth were measured at contact points using a stainless steel digital caliper and Bolton analysis was carried out on them. Results: A clinically and statistically significant anterior TSD (p=0.002) existed in comparison to Bolton’s anterior tooth ratio. Measurements of the overall and anterior TSD between malocclusion groups showed no significant differences (P=0.572, P=0.976 respectively). In terms of gender, no significant differences were observed for the overall TSD data (P=0.102). In Class II division 1 mean overall ratio was lower than Bolton’s, and Class II division 2 mean overall ratio higher than Bolton’s [overall ratio (91.3%, SD ± 2), anterior ratio (77.2, SD ± 2)]. Conclusion: Class II division 1 patients showed a tendency towards excessive maxillary tooth material and Class II division 2 patients showed a tendency towards excessive mandibular tooth material. Keywords: Tooth size discrepancy; Bolton analysis; Bolton ratio, Crowding of teeth
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2017
Vol. 3 No. 2: 10
Research Article
DOI: 10.21767/2469-2980.100044
Journal of Orthodontics & Endodontics
ISSN 2469-2980
iMedPub Journals
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© Under License of Creative Commons Attribution 3.0 License | This Article is Available in: http://orthodontics-endodontics.imedpub.com
Mahmoud NM1, Eltahir HE1
and Mageet AO2*
1 OrthodoncResidentatMageet
OrthodoncTrainingCenter,University
ofGezira,Sudan
2 MohammedBinRashidUniversity,
Dubai,UnitedArabEmirates
*Corresponding author: MageetAO
amageet2000@yahoo.co.uk
AssociateProfessorofOrthodoncs,
MohammedBinRashidUniversity,Dubai,
UnitedArabEmirates.
Tel:+971-5533-78730
Citaon:MahmoudNM,EltahirHE,
MageetAO(2017)ToothSizeDiscrepancy
amongDierentMalocclusionGroupsina
SudaneseSample.JOrthodEndod.Vol.3
No.2:10
Introducon
TSDisdenedasthelackofharmonyofsizeofindividualtooth
orgroupsof teeth when relatedtothosewithinthe same arch
or the opposing arch [1]. It can also be dened as a relave
excessoftoothstructureinonearchinrelaontotheotherarch
[2]. Ideal orthodonc treatment results with opmal occlusion
andidealintercuspation(Class I incisors, canine andmolar
relationship).Overjetandoverbiteisjeopardizedbytooth
size discrepancy [2]. For good occlusion, the upper and
lowerteethmust be proportio nalinsize.Iflargeupperteeth
arecombinedwithsmalllowerteeth,asinadenturesetupwith
mismatched sizes, there is no way to achieve ideal occlusion.
Althoughthenaturalteethmatchverywellrightandleinmost
Received: June28,2017; Accepted: July17,2017; Published: July25,2017
Abstract
Introducon:The standard modeloforthodonc treatment canbedivided into
threedierentstagesasstatedbyProt,namelylevelingandalignment,working
andnishingphases.Eachofthesepresentsdierentchallenges.Inparcularthe
nal,or“nishing” phase, constutes the most complicated for the complexity
ofthe various factors that needto be taken intoaccount if anopmum result
isto beachievedattheend oftreatment.Oneofthese factors,oenaprimary
cause of diculty, is Tooth Size Discrepancy (TSD). Problems arising from this
canbealleviatediftheexistenceofTSDforms partoftheinialdiagnosisandis
consideredwhenformulangatreatmentplanfortheindividualpaent.
Objecves:Thepresentresearchaimedatdeterminingtheextentandprevalence
in a representave orthodonc populaon in Sudan and to invesgate the
dimensionsofTSDinthispopulaonthatcomprisedaclinicallysignicantfactor.
Materials and methods: The sample comprised 107 pretreatment study casts
with fully erupted and complete permanent denons from rst molar to rst
molar,which were selectedrandomlyfromrecords oftheorthodoncpaents.
Themesiodistaldiametersoftheteethweremeasuredatcontactpointsusinga
stainlesssteeldigitalcaliperandBoltonanalysiswascarriedoutonthem.
Results: Aclinicallyand stascally signicant anterior TSD (p=0.002)existedin
comparison to Bolton’s anterior tooth rao. Measurements of the overall and
anterior TSD between malocclusion groups showed no signicant dierences
(P=0.572, P=0.976 respecvely). In terms of gender, no signicant dierences
were observed for the overall TSD data (P=0.102). In Class II division 1 mean
overallrao was lower than Bolton’s, andClass II division 2mean overall rao
higherthanBolton’s[overallrao(91.3%,SD±2),anteriorrao(77.2,SD±2)].
Conclusion: Class II division 1 paents showed a tendency towards excessive
maxillary tooth material and Class II division 2 paents showed a tendency
towardsexcessivemandibulartoothmaterial.
Keywords: Toothsizediscrepancy;Boltonanalysis;Boltonrao,Crowdingofteeth
Tooth Size Discrepancy among
Dierent Malocclusion Groups in
a Sudanese Sample
2017
Vol. 3 No. 2: 10
2
ARCHIVOS DE MEDICINA
ISSN 1698-9465
Journal of Orthodontics & Endodontics
ISSN 2469-2980
This article is available in http://orthodontics-endodontics.imedpub.com
individuals, approximately 5% of the populaon shows some
degreeofdisproporonatelyamongthesizesofindividualteeth
[3]e.g.theupperlateralincisors(Peglateralinoneside).
Manyclinicians haverealizedtheimportanceof TSD.G.V.Black
was the rst to formally invesgate the mesio-distal widths of
teeth [4]. He measured a large number of human teeth and
setup tablesofmean dimensions,whicharesll usedtodayas
reference.
Comparisonbetweenthemesio-distalwidthsofteethwiththe
opposing corresponding tooth on the other side of the dental
archcarriedoutby Ballard[5]. Hisresultsindicatedthat90%of
hissampleshowedarightlediscrepancyinmesio-distalwidth
equalto orexceeding0.25mm. Hissuggestedsoluon was the
strippingofproximalsurfaceswhenalackofbalanceexisted.
Bolton’s[6,7]methodindiagnosingTSDsbyanalyzingthemesio-
distal tooth width rao between the maxillary and mandibular
teethhasbeenwidelyusedsinceitspublicaon.
Variousstudieshavestudiedsexdierencesinrelaonto TSD.
Bishara [8] found that males have larger teeth than females.
Despitethedierencemoststudieshavefoundthatthereislile
impact of gender on interarch raos [8-13]. Smith et al. found
that males had a larger rao than females but the dierences
weresmallandmuchlessthanoneSDfromBoltonnorms[14].
Lavelle [15] showed interest in determining if paents with
dieringmalocclusion groups havedierentnorms of Interarch
ToothSizeDiscrepancy(ITSD).HefoundthatpaentswithAngle
ClassIII malocclusions tend to have higher ITSDthan Class I or
II paents. Araujo and Souki [9] studied 100 paents in each
malocclusionand found thatClassI andIIIpaentshad greater
ITSDthanClassIIpaents.TheyalsofoundthatClassIIIpaents
hadmoreanteriorITSDthanClassIandIIpaents.Howevermany
studieshavefoundnodierencesinITSDbetweenmalocclusion
groups[13,14,16,17].
Aim of the Study
The present study aimed to invesgate the extent of TSD in a
representaveSudaneseorthodoncpopulaonandtoaempt
to determine the size of the discrepancy in millimeters that
constutedaclinicallysignicantdierence.
Materials and Methods
From 107 pretreatment sets of orthodonc study models at
Mageet specialized dental clinic in Khartoum, Sudan, models
wereidenedthatfullledthefollowingcriteria:
• Allpermanentteethhaveerupted.
• Subjects from Sudanese ethnic background determined
fromcaserecords.
• Noretainedprimaryteeth.
• Noabnormaltoothmorphology.
• Nopreviousorthodonctreatment.
• No factors which prevented accurate measurement of
mesiodistal tooth widths including tooth restoraons,
fracturedteeth,orbrokenteethonmodels.
• Themeasurementisrepeatedonemonthaertheinial
measurements for 30 models to assure accuracy (the
margin of error was 0.05 mm)-digital caliber (Figures 1
and 2).
• The mesiodistal widths of 12 maxillary teeth and 12
mandibularteethfromrightrstmolartolerstmolar
are totaled and compared. These mesio-distal crown
measurementsweretakenfrommesialanddistalcontact
areas,respecvely (Figure 3).Thedividendoftwo is the
percentagerelaonshipofmandibular tomaxillary tooth
size,whichiscalled“overallrao”.
Front
Back
Digitalcaliper.Figure 1
Measuringthemesiodistalwidthofteeth.Figure 2
2017
Vol. 3 No. 2: 10
ARCHIVOS DE MEDICINA
ISSN 1698-9465
3
© Under License of Creative Commons Attribution 3.0 License
Journal of Orthodontics & Endodontics
ISSN 2469-2980
Theformofcalculangthetoothsizediscrepancy.Figure 3
30%
70%
Male Female
30%
70%
Male Female
Male Female
Percentageofmalesandfemalesin
thestudy.
Figure 4
49%
38%
3% 10%
49%
38%
3% 10%
I II/1 II/2 III
Percentageofdierentmalocclusions
inthesubjectsofthestudy.
Figure 5
Table 1Comparison between right andlemesiodistaltooth width in
thesample.
Arches Tooth Right Le P-value
Mean SD Mean SD
Maxillary
19.10 0.68 90.00 0.68 0.002
2 7.32 0.65 70.23 0.65 0.004
3 8.13 0.46 80.09 0.48 0.107
4 7.45 0.57 70.50 0.59 0.230
5 7.21 0.54 70.20 0.60 0.795
6 10.72 1.10 10.84 0.63 0.226
Mandibular
1 5.75 0.51 5.69 0.52 0.012
26.23 0.48 6.29 0.46 0.061
3 7.15 0.57 7.06 0.57 0.034
4 7.50 0.59 7.51 0.59 0.874
57.65 0.56 7.60 0.57 0.324
611.27 0.74 11.32 0.75 0.222
Table 2Dierenceintoothsizeandtoothsizediscrepancyinthesample.
Quadrants Tooth Male Female P-value
Mean SD Mean SD
Maxillaryright
11 9.29 0.65 9.02 0.67 0.821
12 7.43 0.54 7.27 0.68 0.224
13 8.33 0.49 8.05 0.42 0.014
14 7.68 0.50 7.35 0.57 0.441
15 7.40 0.60 7.13 0.49 0.107
16 11.00 0.56 10.61 1.25 0.246
Maxillaryle
21 9.26 0.67 8.90 0.66 0.892
22 7.32 0.60 7.19 0.67 0.443
23 8.26 0.53 8.01 0.44 0.011
24 7.68 0.54 8.49 9.32 0.292
25 7.37 0.55 7.12 0.61 0.611
26 11.12 0.67 10.72 0.58 0.572
Mandibularle
31 5.84 0.46 5.62 0.53 0.112
32 6.40 0.48 6.24 0.44 0.214
33 7.25 0.55 6.98 0.56 0.126
34 7.85 0.48 7.37 0.58 0.139
35 7.60 0.61 7.60 0.55 0.590
36 11.80 0.62 11.12 0.71 0.577
Mandibular
right
41 5.92 0.42 5.68 0.53 0.005
42 6.34 0.51 6.19 0.46 0.061
43 7.33 0.62 7.08 0.53 0.021
44 7.78 0.49 7.38 0.59 0.309
45 7.76 0.60 7.60 0.53 0.940
46 11.67 0.66 11.10 0.72 0.814
Results
Therearemore of females in the Orthodonc paents’sample
in Sudan than the males as shown in Figure 4. Figure 5shows
increasepercentageofClassIandClassIIImalocclusionswhilethe
percentageisdecreasedinClassII/1andClassII/2malocclusions
inthesample.
Descripvestascsofmesiodistaltoothwidthcomparedtowith
the dierent malocclusion groups. ANOVA demonstrated that
therewere signicant dierences in upperright lateral incisor,
upperrightcanine,upper le second premolar and lower right
central incisor mesiodistal widths in the dierent malocclusion
groups.
Table 1 compares the mean and standard deviaon of the
widthofthemaxillaryandmandibularteethintherightandle
sides.Stascallysignicantdierenceswerefoundinmaxillary
centralandlateralincisorsandmandibularcentralincisors and
canines. Table 2 reports the mean and standard deviaon of
thewidthofthemaxillaryandmandibularteethinthemaleand
female groups. Both male and female measurements follow a
similarpaern distribuonwiththe maleshavingslightly larger
dentaldimensionsexceptupper le rst premolar. There were
stascallysignicant dierences in mesiodistal tooth widthin
upperrightandlecanine,lowerrightcentralincisorandlower
rightcanine.
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This article is available in http://orthodontics-endodontics.imedpub.com
Table 3Anteriorraoandoverallraooftoothsizediscrepancyofmalesandfemales.
Tooth size discrepancy Males Females P-value
Mean SD Mean SD
AnteriorRao 78.34 2.76 78.30 3.87 0.949
OverallRao 91.82 2.50 90.87 2.81 0.102
Table 4Anteriorraoandoverallraooftoothsizediscrepancyofdierentmalocclusiongroups.
Tooth size
discrepancy
Class I Class II/1 Class II/2 Class III P-value
Mean SD Mean SD Mean SD Mean SD
AnteriorRao 78.44 2.91 78.11 4.49 78.57 1.53 78.37 3.16 0.976
OverallRao 91.37 2.98 90.73 2.63 92.42 2.17 91.38 2.04 0.572
Table 3 shows the mean, standard deviaons of the anterior
and overall tooth size raos in males and females. ANOVA
demonstratednosignicanceinthemale/femalecomparison.
Table 4 summarizes themean values and standard deviaons
ofthe anterior andoveralltoothsize raosinthemalocclusion
groups. ANOVA demonstrated that there were no signicant
dierences in anterior and overall tooth size raos among the
malocclusiongroups.
Discussion
Theclinical importance of TSD intreatment planning has been
the subject of various discussions in orthodonc literature. In
our study, a comparison was made between TSD in dierent
malocclusion groups. This is one of the few studies to be
conductedinSudaninwhichTSDhavebeenstudiedindierent
malocclusiongroups.
Oursamplewasconstruedof70%femalesand30%maleswhich
mayindicatethatfemalesseekorthodonctreatmentmorethan
males.Fromthissample49%hadclassImalocclusion,38%class
IIdiv1andtheremainingdividedbetweenclassIIdiv2andclass
IIIasshowninFigure 4.
Themeanoverallraoforthewholesamplewas91.16%whichis
veryclosetoBolton’sproposedidealrao.Howevertheanterior
rao for the whole sample was found to be 78.31%, which is
higher than Bolton’s proposed ideal rao, thus reecng a
tendencytowards greatermesiodistalwidths inthemandibular
anteriorsegmentinourpopulaonsample.
InclassIandclassIIIpaents,themeanoverallraoscalculated
Table 5Comparisonofmesiodistaltoothwidthinthedierentmalocclusiongroups.
Quadrants Tooth No. Class I Class II/1 Class II/2 Class III P-value
Mean SD Mean SD Mean SD Mean SD
Maxillaryright
11 9.03 0.72 9.18 0.59 8.83 0.76 9.18 0.78 0.619
12 7.08 0.62 7.49 0.59 7.75 0.66 7.68 0.64 0.002
13 8.00 0.44 8.20 0.41 8.33 0.28 8.45 0.56 0.011
14 7.36 0.63 7.54 0.51 7.33 0.57 7.59 0.43 0.369
15 7.08 0.54 7.35 0.51 7.00 0.50 7.31 0.51 0.078
16 10.78 0.59 10.81 0.53 11.00 0.00 10.09 3.07 0.241
Maxillaryle
21 8.89 0.72 9.10 0.59 8.83 0.76 9.22 0.71 0.301
22 7.10 0.59 7.32 0.69 7.25 1.14 7.45 0.56 0.297
23 7.97 0.45 8.17 0.45 8.00 0.86 8.36 0.50 0.051
24 7.43 0.62 7.60 0.50 7.66 0.57 7.45 0.78 0.841
25 7.06 0.57 7.31 0.56 6.83 0.76 7.54 0.68 0.030
26 10.74 0.65 10.89 0.59 11.00 0.50 11.04 0.72 0.429
Mandibularle
31 5.62 0.51 5.70 0.48 5.66 0.57 5.95 0.65 0.300
32 6.24 0.44 6.30 0.47 6.50 0.50 6.40 0.49 0.578
33 6.95 0.52 7.15 0.56 7.00 1.00 7.31 0.64 0.157
34 7.48 0.64 7.56 0.53 7.75 0.66 7.45 0.56 0.789
35 7.55 0.56 7.58 0.54 7.50 0.50 7.93 0.67 0.252
36 11.22 0.80 11.39 0.65 11.41 0.52 11.56 0.86 0.482
Mandibularright
41 5.63 0.53 5.80 0.43 5.66 0.57 6.13 0.50 0.021
42 6.20 0.51 6.23 0.44 6.16 0.28 6.40 0.49 0.648
43 7.06 0.51 7.22 0.54 7.50 0.86 7.22 0.81 0.375
44 7.38 0.59 7.59 0.54 8.16 1.04 7.59 0.49 0.070
45 7.57 0.62 7.73 0.50 7.50 0.50 7.75 0.43 0.515
46 11.07 0.82 11.43 0.58 11.41 0.14 11.59 0.83 0.051
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Journal of Orthodontics & Endodontics
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was 91.37% and 91.38% respecvely, which is closely similar
to Bolton’s ideal rao and the mean anterior raos calculated
was78.44%and78.37%whichishigherthanBolton’sidealrao
(Table 5).
There was a signicant dierence from the ideal for Class II
division 1 and Class II division 2 paents whose corresponding
overallraoswerecalculatedat90.73%and92.42%respecvely.
Here, the relevant anterior raos were 78.11% and 78.57%
respecvely;again,markedlygreaterthanBolton’sidealrao.
These indicate a tendency of maxillary tooth excess in Class II
division 1 malocclusions. This is somewhat in accordance with
Strujicetal.[18];hefoundtherewasatendencyformandibular
tooth excess in subjects with Class III malocclusions and for
maxillarytoothexcessin subjects with Class II malocclusions in
anorthodoncpopulaon.
The higher prevalence of anterior TSDs in this Sudanese
orthodoncpopulaonsuggeststhatatoothsizeanalysisshould
beconductedatthetreatmentplanningstage.Wheresignicant
TSDs are detected, this is normally accommodated by the
reduconoraugmentaonoftoothssue[19].
We were unable to nd any stascally signicant dierences
inthemeanoverallandanteriortooth size raos between the
dierent malocclusion groups. This is in accordance to Uysal
and Sari [17] who idened no dierences in tooth size raos
between malocclusion groups in a Turkish populaon, also in
accordance to O’Mahony and Mille [11] who idened no
stascal dierence in tooth size raos between malocclusion
groupsinanIrishpopulaon,butcontrastswithNieandLin[12]
whoidenedahigherprevalenceofincreasedoveralltoothsize
raosinClass III malocclusions compared toClassIandClass II
malocclusionsinaChinesepopulaon.
In this study the mean anterior tooth size raos exhibited no
stascallysignicantdierencesbetween genders and among
themalocclusiongroups.ThisissimilarinndingstoCrosbyand
Alexander[16],andAraujoandSouki[9].
Also in this study a comparison was made between the le
and right segments of both maxillary and mandibular arches.
Therewasa signicant dierence found betweenleandright
maxillarycentralandlateralincisorsinthemesiodistalwidth,but
nosignicantdierencebetweentherestsofthemaxillaryteeth.
Inthemandibulararch asignicantdierencewasfound inthe
mesiodistalwidthbetweentheleandrightcentralincisorsand
canines.
Conclusion
• ClassI,classII,andclassIIIpaentsshowedmeananterior
toothsizeraoslightlyhigherthanBolton’santeriorrao.
• Class II division 1 paents showed mean overall rao
slightlylower to Bolton’s overall raoand Class division
2paentsshowedmeanoverallraoslightlyhigherthan
Bolton’soverallrao.
• Therewerenostascallysignicantdierencesofoverall
andanteriorTSDwithregardtogenderormalocclusion.
• The results help in treatment planning, pung in
consideraon tooth size discrepancy and decision for
extracon.
Recommendaon
Although Mageet Orthodonc Training Centre caters for all
personnelbelongingto various regions of the country, a larger
studyatthe naonal level is required toverifytheapplicability
oftheseresultstoourpopulaonandalsotocomparebetween
toothsizeandarchlength.
References
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Vol. 3 No. 2: 10
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ARCHIVOS DE MEDICINA
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Journal of Orthodontics & Endodontics
ISSN 2469-2980
This article is available in http://orthodontics-endodontics.imedpub.com
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ontoothsizediscrepancies.AngleOrthod74:508-511.
... 2 Researchers have shown that there are tooth size discrepancies in different malocclusion groups. 3,4 Araujo and Souki 5 found that Class I and Class III patients had greater tooth size discrepancy than Class II patients with mandibular tooth size excess and smaller maxillary teeth in Class III malocclusion groups. 5, 6 Mahmoud NM et al. 4 found Class II Div 1 to have more tooth size materials in maxillary arch and Class II Div 2 to have more tooth size material in mandibular arch. ...
... 3,4 Araujo and Souki 5 found that Class I and Class III patients had greater tooth size discrepancy than Class II patients with mandibular tooth size excess and smaller maxillary teeth in Class III malocclusion groups. 5, 6 Mahmoud NM et al. 4 found Class II Div 1 to have more tooth size materials in maxillary arch and Class II Div 2 to have more tooth size material in mandibular arch. Some other studies done by Uysal T and Sari Z, 7 Crosby DR and Alexander CG, 8 Johe RS et al. 9 and Smith SS et al. 10 showed no differences in tooth size discrepancies in different malocclusion groups. ...
... One way ANOVA showed no correlation in the ratios between the Indo-Aryans and Tibeto-Burmans when compared with Class I, Class II and Class III malocclusion groups (Table 5). 19 and Mahmound NM et al. 4 Sudanese in their study also showed there was increase in the ratio amongst Class III malocclusion groups. 4 The anterior and overall ratios of both the ethnic groups as compared to Bolton's norms was higher but showed no significant differences ( Table 2). ...
Bolton tooth size discrepancy among different malocclusion groups in two different ethnic groups of Nepalese population
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Full-text available
  • Aug 2021
Introduction: The tooth size ratios may vary among different ethnic groups and different malocclusion groups. The objective of this study is to see the tooth size discrepancies in two major ethnic groups of Nepal; Indo-Aryans and Tibeto-Burmans and different malocclusion groups and compare it with the Bolton’s study. Materials and Method: The anterior and overall ratios were compared between Indo-Aryans and Tibeto-Burmans according to different malocclusion groups with Bolton’s study with one sample t-test. The differences in ratios in ethnic groups and gender were seen with one sample t-test. The differences in mesio-distal tooth width amongst the two ethnic groups were seen. One sample ANOVA was used to see any correlation between the ethnic groups and the different malocclusion groups. Result: The anterior ratio and overall ratio in Indo- Aryans and Tibeto-Burmans in all the malocclusion groups were greater than the Bolton’s study but was not statistically significant. There was significant differences in anterior ratio between Indo-Aryans (77.63 + 2.74%) and Tibeto-Burmans (78.51 + 2.76%), p value= 0.024. There were no statistical significant differences in the anterior and overall ratio amongst males and females. The mesio-distal tooth size was greater in Tibeto-Burmans as compared to Indo-Aryans expect for maxillary right and left central incisors. Conclusion: The Tibeto-Burmans had higher anterior ratio as compared to Indo-Aryans. The Tibeto-Burmans had broader teeth as compared to Indo-Aryans except for maxillary central incisors.
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... Quantity I 2 was measured to account for the degree of dispersion of Bolton ratios mean estimates, and the overall homogeneity statistical significance was calculated through the χ2 test 22 . Funnel plots were used to visualize and quantify metaanalysis publication bias, respectively, if appropriate [28][29][30][31][32][33] All tests were two-tailed with alpha set at 0.05 except for homogeneity test whose significance level cutoff was considered to be 0.10 due to the low power of the χ2 test with a limited amount of studies. Unpaired z-test was used to compare our normal occlusion mean results with Bolton original values, with significance level set at 5%. ...
... Globally, the analysis included 8872 participants (2614 men and 3272 women). However, sixteen studies (25,26,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) lacked gender information (2986 participants). Additionally, two multicentre study (12,34) included samples from 2 and 3 different countries and from different continents and, consequently, they were counted as three samples, although in Lavelle (12) the author did not specify the African country preventing it from being analyzed in metaregression. ...
... After 1999 larger datasets were published on different continents. Fifty-two crosssectional studies from four different continents, namely Africa (12,30,34,36,(44)(45)(46), Asia (12,24,25,31,32,34,35,37,38,(40)(41)(42)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58), South America (26,33,39,(59)(60)(61)(62)(63)(64)(65)(66), and Europe (12,22,43,(67)(68)(69)(70)(71)(72)(73)(74) were included in the qualitative synthesis. Lavelle's (12) and Al-Duliamy's (34) were multicentric studies that comprised European, Asian, and African subjects, and Asian and African participants, respectively. ...
A Systematic Review and Meta-Analysis on Bolton's Ratios: Normal Occlusion and Malocclusion
Preprint
Full-text available
  • Feb 2019
Introduction: The purposes of this study were to seek for overall ratio (OR) and anterior ratio (AR) patients data in normal occlusion and Angle’s malocclusion studies, and to assess if such results support Bolton’s standards as general references. Methods: Pubmed, Medline, CENTRAL and Scholar databases were searched up to February 2018 (CRD42018088438). Gray literature was explored through OpenGray. Non-randomized clinical studies, published in English and assessing Bolton’s OR and AR in normal occlusion and Angle’s malocclusion groups (Class I, Class II, Class II division 1, Class 2 division 2, Class III) patients were included. OR and AR means and standard deviations (SD) were collected. Potential covariates (study design, publication year, country where the study was conducted, number of cases, gender, mesiodistal measurement method, and calibration method) were also extracted. The National Health Heart Lung, and Blood Institute’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess each included studies quality. Pairwise Random-Effects and Multilevel Bayesian Network Meta-Analyses were used to synthesize available data. Results: Fifty-two observational studies were included (8872 participants; male/females 2674/3272; 16 studies lacked gender information). For normal occlusion, global pooled estimates for OR and AR means were 91.74% (95% CI: 91.37-92.10) and 78.24% (95% CI: 77.85-78.63), respectively. We could identify on Angle’s Class III patients meaningful OR and AR mean deviations from normal occlusion (0.89, 95% credible interval [CrI], 0.66-1.12, and 0.66, 95% CrI, 0.38-0.94, respectively), while on Class I patients we found a meaningful mean deviation from normal occlusion only for OR (0.25, 95% CrI, 0.03-0.47). Concerning gender impact, male patients presented higher OR (0.30, 95% CI 0.00-0.59) and AR (0.41, 95% CI 0.00-0.83) mean values than females in Class I. Conclusions: The results show that global pooled OR and AR mean values for normal occlusion patients are slightly above Bolton’s original values. Class I, for OR mean values, and Class III, for both OR and AR, are proportionally larger than normal occlusion patients. Gender had almost no impact on teeth mesiodistal proportion.
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... model. The results of this study are comparable with those of Mahmoud et al. (2017), who looked at tooth size differences in Sudanese persons with various malocclusion groups and found that the overall ratio for men was 91.82 and females was 90.87. With p=0.1 (p>0.05), ...
... Our comparison of the TSD results with those recorded by Bolton, shows a slightly higher anterior to overall ratio than the standard value. 5 In a study by Mahmoud et al. (2017), for the sample, 107 pretreatment study casts of completely erupted permanent dentition from first to first molar were employed, which was randomly selected from orthodontic patient records. When compared to Bolton's anterior ratio, the results revealed a clinically and statistically significant difference in anterior size (p = 0.002). ...
Bolton Analysis on Class I, II, and III Malocclusion Cases
Article
Full-text available
  • Jun 2022
Background: Tooth size discrepancy is defined as an imbalance in size between each tooth. To obtain good occlusion with overbite and overjet, the maxillary and mandibular teeth must be of the appropriate size. One of the causes of malocclusion is the mismatch of the mesiodistal size of the teeth to the arch of the jaw. The relation of teeth with a large maxillary mesiodistal size while the mandibular mesiodistal size is small, it is impossible to get an ideal occlusion. This condition is known as tooth size discrepancy and can be a problem when determining the orthodontic treatment plan and when achieving the final orthodontic treatment outcome. Purpose: this study aimed to describe Bolton's analysis in cases of Class I, II, and III malocclusions. Review(s): The literature sources used in preparing the review were through databases PubMed and Google Scholar with the keywords tooth size discrepancy, Bolton analysis, and Class I, II, and III malocclusions. From the results of the researchers' measurements on malocclusions in the Angle Classification Class I and II, The anterior ratio was different in several cases, while in Class III the results were greater than the Bolton ratio, where the size of the lower jaw teeth was larger than the maxillary teeth, especially in the anterior ratio. Conclusion: Bolton's analysis can be applied to all cases regardless of the type of malocclusion, gender, or race, and remains an important investigation before starting treatment for post-treatment arch stability.
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... Tooth size discrepancy (TSD) is a vital feature to diagnose to determine the final canines and molar relationship, the centerline, and esthetics in orthodontic treatment. 1,2,3,4 The mesiodistal width of teeth will affect the arch dimensions (length, width, and form). ...
... The TSD is defined as the lack of symmetry of the mesiodistal width of individual tooth or groups of teeth when related to those within the same opposing arch. 1 It can also be defined as a relative excess of tooth structure in one arch to the other arch. 2 The right and left-side variances that occur in different degrees in the population may cause interference with the standard dental function and esthetic appearance or, on the other hand, maybe so insignificant that it cannot be detected by mere observation. 5,6,7 Therefore, it seems that soft tissues try to compensate for underlying asymmetry. ...
(Print) www.rjptonline.org 0974-360X (Online) Variations of the Mesiodistal width of permanent teeth in a sample of patients attending Ajman University Dental College
Article
Full-text available
  • Dec 2021
The current study aims to measure the variations of the mesiodistal width of permanent teeth in a sample of patients attending Ajman University Dental Hospital. Materials and Method: A Descriptive cross-sectional study of 85 pretreatment study casts of patients (M:33, F:52) aged between 11-38 attending the Orthodontic unit at Ajman University Dental Hospital. The samples were selected randomly for measurements, which were performed using an electronic digital calibre. The width of an individual tooth is measured accurately from the mesial contact point to the distal contact point. The measurement was performed for all the 12 maxillary and mandibular teeth (from 16 to 26 and 36 to 46). The data put up in an excel sheet and sent to the statistician for analysis. Results: Class I and II showed a higher overall ratio and anterior ratio in males with no difference between the gender neither in the anterior or the overall ratio. At the same time, Class III malocclusion had a significant difference in both overall and anterior ratios. The maxillary 1 st premolars and 2 nd premolars teeth have insignificant mesiodistal differences between genders, while the maxillary canine and the 2 nd premolar have a significant difference between right and left quadrants. The mandibular teeth showed no significant difference in mesiodistal width between right and left quadrants. Conclusion: The insignificant difference between the sample and Bolton in the anterior and posterior ratios in Class I & II cases explain the similarity of the racial feature. There is a significant difference in Class III between our sample and the Bolton original work.
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... In a number of articles (Asma, 2013;Bugaighis et al., 2015;Crosby and Alexander, 1989;Kansal et al., 2012;Machado et al., 2018;Mahmoud et al., 2017;McSwiney et al., 2014;O'Mahony et al., 2011;Oktay and Ulukaya, 2010;Uysal et al., 2005), Class II division 1 and division 2 summary statistics were published separately, and it was necessary to calculate the combined mean and SD for the overall Class II following the algorithms in Altman et al. (2000). Similarly, in the studies by McSwiney et al. (2014) and Nie and Lin (1999), there were published data for surgical and non-surgical in Class III, and we used the aforementioned procedure to combine the mean and SD. ...
... In total, the analysis included 11,411 participants (3746 men, 4430 women). However, 16 studies (Al-Duliamy et al., 2016;Alkofide and Hashim, 2002;Asma, 2013;Bugaighis et al., 2015;Cançado et al., 2015;Chugh et al., 2015;Crosby and Alexander, 1989;Kansal et al., 2012;Mahmoud et al., 2017;Manopatanakul and Watanawirun, 2011;McSwiney et al., 2014;Mulimani et al., 2018;Ricci et al., 2013;Shastri et al., 2015;Zerouaoui et al., 2014) lacked gender information (3235 participants). In addition, two multicentre studies (Al-Duliamy et al., 2016;Lavelle, 1972) included samples from two and three different countries and from different continents and, consequently, they were counted as three samples; however, in Lavelle (1972), the author did not specify the African country, preventing it from being analysed in meta-regression. ...
Comparison of InvisalignⓇ Aligners versus Fixed Appliance Treatment in pain perception: a systematic review and meta-analysis
Preprint
Full-text available
  • May 2019
Background: This systematic review aimed to compare the pain discomfort levels between InvisalignⓇ aligners comparing with traditional fixed appliances at multiple time points, through Pain Visual Analog Scale (VAS). Methods: Four electronic databases (Pubmed, Medline, CENTRAL and Scholar) were searched up to February 2019. There were no restrictions on year and publication status. Randomized clinical trials (RCTs) and case-control studies comparing pain perception through VAS in patients treated with Invisalign aligners and with labial appliances were included. Risk of bias within and across studies was assessed using Cochrane tool and Newcastle-Ottawa Scale (NOS) approach. Random-effects meta-analysis were conducted. VAS score at 1, 3 and 7 days, and analgesic consumption was collected. Pairwise and Binary Random-Effects Meta-analyses were used to synthesize available data. Results: At the initial search, a total of 87 articles were retrieved. Following the review protocol, 4 articles met the inclusion criteria and were included, with a total of 214 participants (139 females, 75 males). All studies were considered of high methodological quality. The results demonstrate that Invisalign aligners seems to be associated with significantly less pain than fixed appliances at 7 days after beginning the orthodontic treatment, although at 1 and 3 days the pain experience was similar in both orthodontics appliances. In regard to the type of material, SmartTrackⓇ aligners appear to give significantly better comfort for orthodontic patients than previous standard material, being that 3 days after appliance’s insertion this pain differential becomes significant, and this difference is more pronounced at 7 days. Conclusion: Patients treated with Invisalign experience less pain discomfort than those treated with fixed appliances and consume less analgesics. Overall, Invisalign promotes better pain and discomfort experience for the patient in the course of orthodontic treatment. Larger RCTs are needed to definitely demonstrate these findings throughout the orthodontic treatment.
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... In a number of articles (Asma, 2013;Bugaighis et al., 2015;Crosby and Alexander, 1989;Kansal et al., 2012;Machado et al., 2018;Mahmoud et al., 2017;McSwiney et al., 2014;O'Mahony et al., 2011;Oktay and Ulukaya, 2010;Uysal et al., 2005), Class II division 1 and division 2 summary statistics were published separately, and it was necessary to calculate the combined mean and SD for the overall Class II following the algorithms in Altman et al. (2000). Similarly, in the studies by McSwiney et al. (2014) and Nie and Lin (1999), there were published data for surgical and non-surgical in Class III, and we used the aforementioned procedure to combine the mean and SD. ...
... In total, the analysis included 11,411 participants (3746 men, 4430 women). However, 16 studies (Al-Duliamy et al., 2016;Alkofide and Hashim, 2002;Asma, 2013;Bugaighis et al., 2015;Cançado et al., 2015;Chugh et al., 2015;Crosby and Alexander, 1989;Kansal et al., 2012;Mahmoud et al., 2017;Manopatanakul and Watanawirun, 2011;McSwiney et al., 2014;Mulimani et al., 2018;Ricci et al., 2013;Shastri et al., 2015;Zerouaoui et al., 2014) lacked gender information (3235 participants). In addition, two multicentre studies (Al-Duliamy et al., 2016;Lavelle, 1972) included samples from two and three different countries and from different continents and, consequently, they were counted as three samples; however, in Lavelle (1972), the author did not specify the African country, preventing it from being analysed in meta-regression. ...
A systematic review and meta-analysis on Bolton’s ratios: Normal occlusion and malocclusion
Article
Full-text available
  • Nov 2019
Introduction The purpose of this study was to seek and summarise the Bolton overall index (OI) and anterior index (AI) regarding normal occlusion and Angle’s malocclusion according to gender, and to assess if these indices support Bolton’s standards as general references. Methods PubMed, LILACS, Embase, CENTRAL and Google Scholar databases were searched up to June 2019 (CRD42018088438). Non-randomised clinical studies, published in English and assessing Bolton’s OI and/or AI in normal occlusion and Angle’s malocclusion groups, were included. OI and AI means, sample size and SDs were collected. The National Heart, Lung, and Blood Institute’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias. Pairwise random-effects and multilevel Bayesian network meta-analyses were used to synthesise available data. Results Fifty-three observational studies were included (11,411 participants; 3746 men, 4430 women; 15 studies lacked gender information). For normal occlusion, pooled estimates for OI and AI means were 91.78% (95% confidence interval [CI] = 91.42–92.14; I ² = 92.87%) and 78.25% (95% CI = 77.87–78.62; I ² = 90.67%), respectively. We could identify in Angle’s Class III patients meaningful OI and AI mean deviations from normal occlusion (0.76, 95% credible interval [CrI] = 0.55–0.98 and 0.61, 95% CrI = 0.35–0.87, respectively), while in Class II patients we found a meaningful mean deviation from normal occlusion only for OI (−0.28, 95% CrI = −0.52–−0.05). Concerning gender impact, male patients presented higher OI (0.30, 95% CI = 0.00–0.59) and AI (0.41, 95% CI = 0.00–0.83) mean values than female patients in Class I. Conclusion Normal occlusion OI and AI mean values differ from Bolton’s original values. Class II division 2, for OI mean values, and Class III, for both OI and AI, are proportionally larger than normal occlusion patients. Gender had almost no impact on teeth mesiodistal proportion.
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... In a number of articles (Asma, 2013; Bugaighis et al., 2015;Crosby and Alexander, 1989;Kansal et al., 2012;Machado et al., 2018;Mahmoud et al., 2017;McSwiney et al., 2014;O'Mahony et al., 2011;Oktay and Ulukaya, 2010;Uysal et al., 2005), Class II division 1 and division 2 summary statistics were published separately, and it was necessary to calculate the combined mean and SD for the overall Class II following the algorithms in Altman et al. (2000). Similarly, in the studies by McSwiney et al. (2014) and Nie and Lin (1999), there were published data for surgical and non-surgical in Class III, and we used the aforementioned procedure to combine the mean and SD. ...
... In total, the analysis included 11,411 participants (3746 men, 4430 women). However, 16 studies (Al-Duliamy et al., 2016;Alkofide and Hashim, 2002;Asma, 2013;Bugaighis et al., 2015;Cançado et al., 2015;Chugh et al., 2015;Crosby and Alexander, 1989;Kansal et al., 2012;Mahmoud et al., 2017;Manopatanakul and Watanawirun, 2011;McSwiney et al., 2014;Mulimani et al., 2018;Ricci et al., 2013;Shastri et al., 2015;Zerouaoui et al., 2014) lacked gender information (3235 participants). In addition, two multicentre studies (Al-Duliamy et al., 2016;Lavelle, 1972) included samples from two and three different countries and from different continents and, consequently, they were counted as three samples; however, in Lavelle (1972), the author did not specify the African country, preventing it from being analysed in meta-regression. ...
A Systematic Review and Meta-analysis on Bolton's ratios: Normal occlusion and Malocclusion
Article
Full-text available
  • Oct 2019
  • J Orthod
Introduction: The purposes of this study were to seek and summarize overall index (OI) and anterior index (AI) regarding normal occlusion and Angle’s malocclusion and according to gender, to assess if such results support Bolton’s standards as general references. Methods: Pubmed, LILACS, Embase, CENTRAL and Google Scholar databases were searched up to June 2019 (CRD42018088438). Non- randomized clinical studies, published in English and assessing Bolton’s OI and/or AI in normal occlusion and Angle’s malocclusion groups were included. OI and AI means, sample size and standard deviations (SD) were collected. The National Health Heart Lung, and Blood Institute’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias. Pairwise Random-Effects and Multilevel Bayesian Network Meta-Analyses were used to synthesize available data. Results: Fifty-three observational studies were included (11411 subjects; male/females 3746/4430; 15 studies lacked gender information). For normal occlusion, pooled estimates for OI and AI means were 91.78% (95% CI: 91.42-92.14; I2=92.87%) and 78.25% (95% CI: 77.87- 78.62; I2=90.67%), respectively. We could identify on Angle’s Class III patients meaningful OI and AI mean deviations from normal occlusion (0.76, 95% credible interval [CrI], 0.55-0.98, and 0.61, 95% CrI, 0.35- 0.87, respectively), while on Class II patients we found a meaningful mean deviation from normal occlusion only for OI (-0.28, 95% CrI, - 0.52- -0.05). Concerning gender impact, male patients presented higher OI (0.30, 95% CI 0.00-0.59) and AI (0.41, 95% CI 0.00-0.83) mean values than females in Class I. Conclusions: Normal occlusion OI and AI mean values differ from Bolton’s original values. Class II division 2, for OI mean values, and Class III, for both OI and AI, are proportionally larger than normal occlusion patients. Gender had almost no impact on teeth mesiodistal proportion.
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... In a number of articles (Asma, 2013;Bugaighis et al., 2015;Crosby and Alexander, 1989;Kansal et al., 2012;Machado et al., 2018;Mahmoud et al., 2017;McSwiney et al., 2014;O'Mahony et al., 2011;Oktay and Ulukaya, 2010;Uysal et al., 2005), Class II division 1 and division 2 summary statistics were published separately, and it was necessary to calculate the combined mean and SD for the overall Class II following the algorithms in Altman et al. (2000). Similarly, in the studies by McSwiney et al. (2014) and Nie and Lin (1999), there were published data for surgical and non-surgical in Class III, and we used the aforementioned procedure to combine the mean and SD. ...
... In total, the analysis included 11,411 participants (3746 men, 4430 women). However, 16 studies (Al-Duliamy et al., 2016;Alkofide and Hashim, 2002;Asma, 2013;Bugaighis et al., 2015;Cançado et al., 2015;Chugh et al., 2015;Crosby and Alexander, 1989;Kansal et al., 2012;Mahmoud et al., 2017;Manopatanakul and Watanawirun, 2011;McSwiney et al., 2014;Mulimani et al., 2018;Ricci et al., 2013;Shastri et al., 2015;Zerouaoui et al., 2014) lacked gender information (3235 participants). In addition, two multicentre studies (Al-Duliamy et al., 2016;Lavelle, 1972) included samples from two and three different countries and from different continents and, consequently, they were counted as three samples; however, in Lavelle (1972), the author did not specify the African country, preventing it from being analysed in meta-regression. ...
A Systematic Review and Meta-analysis on Bolton's ratios: Normal occlusion and Malocclusion
Preprint
Full-text available
  • Feb 2019
Introduction: The purposes of this study were to seek for overall ratio (OR) and anterior ratio (AR) patients data in normal occlusion and Angle’s malocclusion studies, and to assess if such results support Bolton’s standards as general references. Methods: Pubmed, Medline, CENTRAL and Scholar databases were searched up to February 2018 (CRD42018088438). Gray literature was explored through OpenGray. Non-randomized clinical studies, published in English and assessing Bolton’s OR and AR in normal occlusion and Angle’s malocclusion groups (Class I, Class II, Class II division 1, Class 2 division 2, Class III) patients were included. OR and AR means and standard deviations (SD) were collected. Potential covariates (study design, publication year, country where the study was conducted, number of cases, gender, mesiodistal measurement method, and calibration method) were also extracted. The National Health Heart Lung, and Blood Institute’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess each included studies quality. Pairwise Random-Effects and Multilevel Bayesian Network Meta-Analyses were used to synthesize available data. Results: Fifty-two observational studies were included (8872 participants; male/females 2674/3272; 16 studies lacked gender information). For normal occlusion, global pooled estimates for OR and AR means were 91.74% (95% CI: 91.37-92.10) and 78.24% (95% CI: 77.85-78.63), respectively. We could identify on Angle’s Class III patients meaningful OR and AR mean deviations from normal occlusion (0.89, 95% credible interval [CrI], 0.66-1.12, and 0.66, 95% CrI, 0.38-0.94, respectively), while on Class I patients we found a meaningful mean deviation from normal occlusion only for OR (0.25, 95% CrI, 0.03-0.47). Concerning gender impact, male patients presented higher OR (0.30, 95% CI 0.00-0.59) and AR (0.41, 95% CI 0.00-0.83) mean values than females in Class I. Conclusions: The results show that global pooled OR and AR mean values for normal occlusion patients are slightly above Bolton’s original values. Class I, for OR mean values, and Class III, for both OR and AR, are proportionally larger than normal occlusion patients. Gender had almost no impact on teeth mesiodistal proportion.
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... The relationship between malocclusion type and tooth size proportions has also been reported. 1,[3][4][5][6][7] Since differences in tooth size have been reported with ethnic groups, 3,[8][9][10][11] most of the practitioners now disagree to apply the tooth size reported from the other ethnic groups. Bishara et al. 11 conducted a study which includes the population of Egypt, Mexico, and the United States. ...
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... The relationship between malocclusion type and tooth size proportions has also been reported. 1,[3][4][5][6][7] Since differences in tooth size have been reported with ethnic groups, 3,[8][9][10][11] most of the practitioners now disagree to apply the tooth size reported from the other ethnic groups. Bishara et al. 11 conducted a study which includes the population of Egypt, Mexico, and the United States. ...
Mesio-distal crown width in permanent dentition amongst adolescent population of Province II of Nepal
Article
Full-text available
  • Jun 2020
Background: The purpose of this study was to gather normative data on the mesio-distal crown dimensions amongst adolescent population of Province II, Nepal, to make an accurate diagnosis and treatment planning in orthodontics. It will also be useful in various clinical disciplines of dentistry including basic dental and anthropological research. Materials and Methods: Samples were selected Full form OPD of M B Kedia Dental College, Birgunj, Nepal. Total numbers of participants were 120, out of which 60 males and 60 females were selected after initial examination aged between 11 to 23 years. Subjects with all permanent teeth erupted (except second and third molar) without any history of previous orthodontic treatment and with no dental anomalies were included in this study. The alginate impressions were made by the well trained dental surgeon. Digital vernier calliper providing measurements to ± 0.01millimeter(mm) was used to measure the mesio-distal dimension of all teeth. Results: The mean, range and standard deviation were calculated for the size of the teeth. Independent t-test was used to compare between male and female population. The significance level was set at p value <= 0.05. The population of Province II, Nepal shows greater sexual dimorphism in mesio-distal crown dimension which was exhibited by the maxillary molars (0.88 mm) followed by mandibular molars (0.38 mm). Similarly in anterior tooth segment the maxillary canines (0.29 mm) followed by the mandibular canines (0.27 mm). Conclusion: The mean mesio-distal crown dimensions of the permanent dentition of males were larger than that of females for each type of tooth except maxillary central and lateral incisor.
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Tooth size discrepancies in Irish orthodontic patients among different malocclusion groups
Article
Full-text available
  • Jan 2011
  • ANGLE ORTHOD
To determine the prevalence of tooth size discrepancies (TSDs) in an Irish orthodontic population among different malocclusion groups. From 850 pretreatment sets of orthodontic models at a university clinic, 240 were selected with 30 female and 30 male sets for each malocclusion (Class I, Class II division 1, Class II division 2, and Class III). Digital models were produced, and the mesial and distal contact points were digitized to calculate overall and anterior tooth size ratios. The differences between the male and female groups and among the malocclusion groups were analyzed using two-way analysis of variance (ANOVA) (P < .05). A clinically significant anterior TSD (more than two standard deviations from the Bolton means) existed in 37.9% of the subjects. No differences existed in the prevalence of overall TSDs between the male and female groups (P  =  .5913) or among the malocclusion groups (P  =  .0809). For the mean anterior tooth size ratios in the male group, the values for Class III and Class II division 2 were higher than in Class II division 1, and the value for Class II division 2 was higher than in Class I (P  =  .0184). The prevalence of anterior tooth size discrepancies in this sample of Irish orthodontic patients was 37.9%. There were no statistically significant differences in the prevalence of mean overall TSDs with regard to malocclusion or gender. In the male group, the mean anterior tooth size ratio was higher in Class III and in Class II division 2 malocclusion than in Class II division 1 and higher in Class II division 2 malocclusion than in Class I malocclusion.
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Intermaxillary tooth-size discrepancies in different sexes, malocclusion groups, and ethnicities
Article
  • Nov 2010
To achieve proper occlusion, practitioners must consider tooth-size discrepancies between the jaws. Previous studies have shown considerable differences in tooth sizes between sexes, ethnicities, and malocclusion categories. The aim of this study was to compare mean tooth-size statistics between these groups, specifically determining a maxillary or a mandibular excess tooth-size discrepancy in clinically relevant cases. This study involved 306 subjects of varying sex, ethnicity, and malocclusion category, randomly chosen from the treatment population of the orthodontic clinic at the New Jersey Dental School, University of Medicine and Dentistry of New Jersey. The prevalence of discrepancies (±1 and 2 SD) between all groups and within groups was measured. Fifty percent of the subjects had anterior Bolton tooth-size discrepancies, and 41% had overall Bolton tooth-size discrepancies of ±1 SD. Tooth-size ratios compared with analysis of variance (ANOVA) showed no significant correlation between and among the sexes, ethnicities, and malocclusion groups. Compared with Caucasian and Hispanic patients, African-American patients had significantly greater odds of having a clinically significant (±2 SD) anterior ratio. When we compared the numbers of subjects above or below the clinically significant ratio, there was equal distribution of maxillary and mandibular excess in Class II and Class III patients. Caucasian and African-American patients had equal distributions of maxillary and mandibular excess, whereas Hispanic patients displayed a higher bias toward mandibular excess. Tooth-size discrepancies are common in orthodontic populations and are evenly distributed among sex, ethnicity, and malocclusion category, with some exceptions.
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The occurrence of tooth size discrepancies among different malocclusion groups
Article
  • Jul 1989
  • AM J ORTHOD DENTOFAC
This study consisted of 109 patients with varying malocclusions (Class I; Class II, Division 1; Division 2; and Class II surgery) who were treated orthodontically. Tooth size analyses were performed on the pretreatment models of these patients and mesial-distal tooth size ratios were measured as described by Bolton. The incidence of mesial-distal tooth size discrepancies in the malocclusion groups was analyzed and compared with Bolton's means and standard deviations. The results showed no difference in the incidence of tooth size discrepancies from one malocclusion group to another. When the sample was taken as a whole, there was no significant difference in the mean of the mesial-distal tooth size ratios as computed in the present study and compared to Bolton's mean. There were, however, higher standard deviations seen in the present study compared with Bolton's study. Even though there was no significant difference in the incidence of tooth size discrepancies among malocclusion groups, there was a large number of tooth size discrepancies in each group. Therefore it is suggested that Bolton's tooth size analysis be performed before initiation of orthodontic treatment.
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Orthodontic-restorative treatment for relative mandibular anterior excess tooth-size problems
Article
  • Mar 1981
  • Am J Orthod
The diagnostic and conventional treatment techniques used to resolve relative mandibular anterior excess tooth-size problems are reviewed. An alternative solution to these problems, which involves an orthodontic-restorative technique, is described. Specific problems which may be encountered with this technique are also discussed. Three cases are presented, with posttreatment documentation for at least one year. It appears that this technique offers a successful semipermanent treatment for selected cases.
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Comparison of intermaxillary tooth size discrepancies among different malocclusion groups
Article
  • Nov 1999
  • AM J ORTHOD DENTOFAC
The purpose of this study was to determine whether there is a prevalent tendency for intermaxillary tooth size discrepancies among different malocclusion groups. This study consisted of 60 subjects who served as the normal occlusion group and 300 patients divided into 5 malocclusion groups (ie, Class I with bimaxillary protrusion, Class II Division 1, Class II Division 2, Class III, and Class III surgery). Tooth size measurements were performed on the models of normal occlusion and pretreatment models of patients by the Three Dimension Measuring Machine. Moreover, tooth size ratios, analyzed as described by Bolton and the Student t test showed no sexual dimorphism for these ratios in each of 6 groups, so the sexes were combined for each group. Then these ratios were compared among different malocclusion groups. The results showed no significant difference between subcategories of malocclusion, so these groups were combined. There were now 120 cases in each of 3 categories: Class I, Class II, and Class III. A significant difference was found for all the ratios between the groups, the ratios showing that Class III > Class I > Class II. It demonstrated that intermaxillary tooth size discrepancy may be one of the important factors in the cause of malocclusions, especially in Class II and Class III malocclusions. Thus this study proved the fact that Bolton analysis should be taken into consideration during orthodontic diagnosis and therapy.
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