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Tooth Width and Arch Dimensions in Normal and Malocclusion
Samples:
An Odontometric Study
The purpose of this study was to establish tooth width and arch
dimensions in normal and malocclusion samples and to compare tooth
width and arch dimensions between males and females in normal and
malocclusion samples. A total of 120 pairs of orthodontic study
casts were included in the study. An electronic digital caliper was
used for the measurements. Descriptive statistics and the t-test
were used for the statistical analysis of the data. Tooth width and
arch dimensions were established in normal and malocclusion in the
present study. Significant differences were found in tooth width
between normal and malocclusion samples. However, no significant
difference was observed in arch dimensions. Furthermore, there was
statistical significant difference in tooth width between males and
females where the males showed higher mean values. The same was
true when arch dimensions were compared. The results of the current
investigation are of great value to the anthropologist as well as
to the orthodontist in understanding dimensional arch criteria and
orthodontic arch wire selection. Furthermore, it helps the
prosthodontist in the selection of the correct shape and size of
stock impression trays and of suitable molds of artificial teeth
for fixed and removable prostheses.
Keywords: Tooth width, dental arch dimensions, malocclusion,
Dahlberg’s formula
Citation: Hashim HA, Al-Ghamdi SAF. Tooth Width and Arch
Dimensions in Normal and Malocclusion Samples: An Odontometric
Study. J Contemp Dent Pract 2005 May;(6)2:036-051.
Abstract
© Seer Publishing
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IntroductionDental casts are still considered a vital diagnostic
tool in orthodontic practice.1 The dental cast facilitates the
analysis of tooth size and shape; alignment and rotations of the
teeth; presence or absence of teeth; arch width, length, form and
symmetry; and the occlusal relationship.2
A relative harmony in the mesiodistal dimension of the maxillary
and mandibular teeth is a major factor in coordinating posterior
interdigitation, overbite, and overjet in centric occlusion.3 Tooth
size must also be in harmony with arch size to allow proper
alignment.4
A significant variation in this harmony will lead to
malocclusion and difficulties in obtaining an occlusion with
optimal overjet, overbite, and class I canine and molar
relationships. Although the natural teeth match very well in most
individuals, approximately 5% of the population have some degree of
discrepancy among the sizes of individual teeth.5
An anomaly in the size of the maxillary lateral incisors is the
most common cause of tooth size discrepancy, but variation in
premolars or other teeth may be present.5 These can be difficult to
detect by inspection alone. However, comparing the size of upper
and lower lateral incisors can provide a quick check for this
discrepancy. Adiscrepancy almost surely exists unless the upper
lateral incisor is 12-14% wider than the lower lateral
incisor.6
Discrepancies in intermaxillary tooth size can be assessed using
either a diagnostic setup or it can be predicted using a
mathematical formula such as the Bolton analysis.7 If the
discrepancy goes undetected, initially it may lead to delays in the
completion of the treatment or to a compromised
result. Therefore, the ability to analyze the proportionality of
the maxillary and mandibular teeth is an important diagnostic tool
that would best be used at the initial diagnostic stage.
Mesiodistal tooth size is an important factor in orthodontic
diagnosis and treatment planning.8
To achieve optimal occlusion, the maxillary and mandibular teeth
must be proportional in size. If there is mismatch, there is no way
to achieve optimal occlusion.9 This mismatch is defined as tooth
size discrepancy.
At the beginning of this century, G.V. Black10
conducted one of the most classical investigations on the
subject of tooth size. Although a large number of human teeth were
measured, and tables of mean figures were established for each
tooth in the dental arch, Black’s study was based upon a sample of
unknown size and racial origin.
Review of the literature reveals variations in tooth size exist
between different racial groups.11 Therefore, different diagnostic
standards should be established for each racial group in order to
provide an effective diagnostic standard.
Hashim and Murshid12-14 conducted a study on a Saudi sample with
different types of malocclusion and found the first molars
exhibited the least coefficient of variation in size, while the
central and lateral incisors showed the most variation in size.
They also indicated there was no significant statistical difference
between the right and left sides. Thus, measurement of one side
could
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An equal distribution of male and female samples was
maintained.
Dental Study Cast MeasurementsMeasurements were made directly on
the un-soaped plaster dental casts. One operator took all the
measurements under natural and neon light. An electronic digital
caliper (Digimatic caliper, Mitutoyo, UK) was used to measure the
following variables (Figure1):
1. Mesiodistal tooth width2. Inter-canine width3. Inter-molar
width4. Arch length
Mesiodistal tooth width: The procedure for measuring the
mesiodistal tooth width was performed as described by Hunter and
Priest.17 The caliper beaks were inserted from the facial aspect of
the teeth and held perpendicular to the long axis of the tooth. The
beaks were then closed until gentle contact with the predetermined
contact points of the tooth was made. The measurements included the
mesiodistal width of all the twelve maxillary and mandibular teeth
from the right first permanent molar to the left first permanent
molar on 90 pairs of casts (the malocclusion group), since the
measurements of the remainder of the 30 pairs (the normal occlusion
group) were obtained from a previous study.16 The dimensions are
defined as follows:
• Inter-canine width: The horizontal dis-tance between cusp tips
of the upper and lower permanent canines.18
• Inter-molar width: The horizontal distance between the right
and left central fossae of the upper and lower first permanent
molars.18
• Arch length: The distance from the distal
be representative when the corresponding measurement on the
other side was unobtainable. Furthermore, the canines in both jaws
exhibited significant differences between the sexes while the other
teeth did not.
Detection of tooth size discrepancies is one of the important
diagnostic aids which allow orthodontists to gain insight into the
functional and esthetic outcome of a given case. However,there is
little information regarding this issue among the Saudi population
where there is a relatively large need for orthodontic
treatment.15
The aims of the present study were to:
1. Establish mesiodistal tooth width and arch dimensions in a
sample with normal occlu-sion (Class I) and malocclusion (i.e.,
Class II and Class III).
2. Compare mesiodistal tooth width and arch dimensions between
normal occlusion and malocclusion.
3. Compare mesiodistal tooth width and arch dimensions between
both sexes.
Materials and MethodsA total of 120 pairs of orthodontic study
casts were included in this study. Ninety casts were selected
randomly from the dental school at King Saud University in Riyadh
and thirty were obtained from a previous study.16
The criteria for sample selection were as follows:
• Patient age ranged from 15 to 25 years• Presence of all
permanent teeth from
central incisors to first molars in all four quadrants
• No evidence of bubbles or fractured teeth• No history of
previous orthodontic treatment
The sample was selected according to Angle’s classification and
contained the following:
• Thirty pairs of Class I normal occlusion designated as the
normal occlusion group
• Thirty pairs of Class I• Thirty pairs of Class II and thirty
pairs of
Class III malocclusion were combined and designated as
malocclusion group
Figure 1: The Digimatic caliper.
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surface of the second premolar to the distal surface of the
lateral incisor and from there to the midline. This is repeated on
both sides. These values are computed to determine the arch length
in each dental arch.
Statistical AnalysisThe data of the present study was subjected
to statistical analysis utilizing a computer program SPSS,
“Statistical Package for the Social Science” version 10.0. The
following tests were carried out:
Statistical Assessment of Measurement ErrorsAll measurements
were repeated after one week by the same operator on five pairs of
dental casts (120 teeth and 20 arch widths) to determine the error
of the method using Dahlberg’s method.19
Dahlberg’s formula
Where (d) is the difference between the two readings and (n) is
the number of duplicates.
Descriptive StatisticsThe following descriptive statistics were
calculated for each variable:
1. Mean2. Standard deviation3. Standard error of the mean4.
Coefficient of variance
Statistical Comparison between GroupsAn independent t-test was
used for comparison between the groups.
The Level of SignificanceA level of significance of 5% was used
for the rejection of the null hypothesis. One asterisk (*)
represents p
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Table 3. The mean, standard deviation, standard error of the
mean and coefficient of variation of individual tooth in normal
occlusion group for both sexes (n= 30)*.
Table 4. The mean, standard deviation, standard error of the
mean and coefficient of variation of individual tooth in
malocclusion group for both sexes (n= 90)*.
Table 2. Error of the method for arch dimensions by Dahlberg’s
method (n= 5)*.
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was found the upper right first molar showed the least
variability, whereas the lower right second premolar showed the
highest variability.
Tables 4 shows the descriptive statistics for mesiodistal tooth
width in the malocclusion group. It showed when the variability of
tooth width was studied by means of coefficient of variation, it
was found the upper right first premolar showed the least
variability, whereas the upper left lateral incisor showed the
highest variability.
Comparison of Mesiodistal Tooth Width between Normal Occlusion
and MalocclusionTable 5 (a) and 5 (b) shows statistical comparison
of mesiodistal tooth width between the normal occlusion group and
the malocclusion group. Inthe malocclusion group the mesiodistal
tooth width of the upper and lower central incisors, lower left
lateral incisor, and lower first molars were significantly higher
than in the normal occlusion group.
Comparison of Mesiodistal Tooth Width between Males and
FemalesTable 6 (a) and 6 (b) shows a statistical comparison of
mesiodistal tooth width between the males and the females. It
showed the
males have greater mesiodistal tooth width than the females in
most of the upper and lower teeth. The maxillary and mandibular
canines, maxillary left central incisor, mandibular left lateral
incisor, and mandibular first molars demonstrated statistical
significant differences when values for the males and females were
compared. While insome teeth in which the females demonstrated
greater readings, the difference was not statistically
significant.
Arch DimensionsTable 7 shows the descriptive statistics for arch
dimensions in the normal occlusion group. Both inter-canine and
inter-molar widths and arch length in the maxilla showed less
variability than in the mandible.
Table 8 shows the descriptive statistics for arch dimensions in
the malocclusion group. Bothinter-molar width and arch length in
the mandible showed less variability than the maxilla, whereas the
opposite was found related to the inter-canine width.
Comparison of Arch Dimensions Between Normal Occlusion and
MalocclusionTable 9 shows statistical comparison of arch dimensions
between the normal occlusion
Table 5(a). Statistical comparison of mesiodistal tooth width
between normal occlusion and malocclusion for both sexes in the
upper jaw*.
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Table 5(b). Statistical comparison of mesiodistal tooth width
between normal occlusion and malocclusion for both sexes in the
lower jaw*.
Table 6(a). Statistical comparison of mesiodistal tooth width
between males and females in the upper jaw*.
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Table 6(b). Statistical comparison of mesiodistal tooth width
between males and females in the lower jaw*.
Table 7. The mean, standard deviation, standard error of the
mean and coefficient of variation of individual tooth in normal
occlusion group for both sexes (n= 30)*.
Table 8. The mean, standard deviation, standard error of the
mean and coefficient of variation for arch dimensions in
malocclusion group for both sexes (n= 90)*.
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group and the malocclusion group. It shows no statistical
significant difference was found in arch dimensions between the two
groups.
Comparison of Arch Dimensions between Males and FemalesTable 10
shows statistical comparison of arch dimensions between the males
and the females. It shows statistically significant sex differences
in arch dimensions. The inter-canine and inter-molar widths and
arch length in the maxilla and mandible were greater in the males
than the females.
DiscussionThe mesiodistal tooth size of the maxillary and
mandibular arch must relate to each other in order to obtain an
optimal occlusion at the completion of the orthodontic treatment.20
If a patient has significant tooth size discrepancy, orthodontic
alignment into optimal occlusion may not be possible.21 Crosby and
Alexander22 and Freeman et al.23 reported a large percentage of
orthodontic patients possess significant tooth size discrepancies.
Therefore, orthodontists should be aware of the existence of these
discrepancies before beginning orthodontic treatment. The
treatment
Table 9. Statistical comparison for arch dimensions between
normal occlusion and malocclusion for both sexes*.
Table 10. Statistical comparison of arch dimensions between
males and females*.
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alternatives for tooth size discrepancies include restoration of
relatively small teeth, interproximal striping of relatively large
teeth, modification of crown angulation or inclination, and
extraction.24
The age range of the subjects in the present study was between
15 to 25 years “early adulthood.” Doris et al.25 indicated early
permanent dentitions provide the best sample for tooth size
measurements because early adulthood dentitions has less mutilation
and less attrition in most individuals. Consequently, the effect of
these factors on the actual mesiodistal tooth width will be
minimum. Researchers, who studied growth changes in the arch
widths, found inter-canine and inter-molar widths did not change
after the age of thirteen years in females and sixteen years in
males.26-28 Therefore, it was assumed inter-canine and inter-molar
widths of the subjects selected in the present study were
stable.
The question of the accuracy of plaster casts made from alginate
impressions as a representation of the actual mesiodistal tooth
width was investigated by Hampson29, Beresford30,Miller31, and
Coleman32 et al. The outcome of these studies indicated alginate
impressions produce the most accurate dental casts when poured
immediately. Furthermore, Hunter and Priest17 indicated there was
considerable advantage in the measurement of teeth on the dental
cast rather than measuring teeth directly in the mouth. Therefore,
it should not be assumed the clinical measurements are necessarily
more accurate than those obtained from plaster models.
Previous studies calculated the error of the method of an
individual tooth width by Dahlberg’s method. The error of the
individual tooth width found by various studies were as follows:
LundstrÖm33, 34 were in the range of 0.06 mm-0.25 mm; Sanin and
Savara35 were0.05 mm-0.11 mm; Towsend and Brown36 were 0.09 mm-
0.18 mm, while those by Hashim and Murshid37, 38, 12 were 0.02
mm-0.30 mm. In the present study the error of the individual tooth
width ranged from 0.02 mm-0.37 mm. These disagreements could be due
to the different types of measuring devices and methodology
used.
Variability in the size of the teeth was studied by means of
coefficient of variation. The result of
the current study showed the first molars in both jaws had the
least variability, whereas the lower right second premolar had the
highest. This is in partial agreement with the results obtained by
earlier investigators.39 Lunt40 noticed the first molars of both
jaws showed the lowest variability, while the third molar and
lateral incisor of both jaws had the highest degree of variability
in size. However, in the present study third molars were not
included. Moreover, the results of the present study were in
agreement with the findings of Hashim and Murshid38 who reported
that first molars exhibited the least variability in mesiodistal
tooth width in a Saudi sample.
Sex differences in mesiodistal tooth width have been of interest
to several earlier investigators. In the present study the males
had larger teeth than females, and the canines in both jaws
displayed a statistically significant sexual dimorphism in
mesiodistal tooth size. This was in agreement with the results of
Moorrees41, Stahle42, Mack43,Kellam44, Bishara et al.45, Hashim and
Murshid13, and Hattab et al.46 In addition to the canine, lower
first molars also showed a statistically significant sexual
dimorphism in mesiodistal tooth size. Selmer-Oslen47 found the
greatest sex differences were in the canines and the premolars. No
significant difference was observed in premolars in the present
study.
The results of the present study show the inter-canine and
inter-molar widths were greater in males than in females. This is
in agreement with the result obtained by Tavas48 in a British
sample, Younes49, and Diwan and Elahi50 in a Saudisample, but in
disagreement with the finding of Sarhan and Diwan51 in a Egyptian
sample. Theresult of the arch length measurements showed the males
had significantly greater arch length than the females. However, no
statistical significance was noted between both sexes in a study
carried out by Hashim and Ghamdi52
in a Saudi sample collected from the AL-Baha area. This was not
consistent with the results of the current study. On the other
hand, when comparing the arch width and length between the
malocclusion group and the normal occlusion group, no statistical
significant difference was observed. The mean values of the upper
inter-canine and inter-molar widths of the present study were lower
than those reported by Younes49
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11The Journal of Contemporary Dental Practice, Volume 6, No. 2,
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and Diwan and Elahi50 in Saudi subjects. This difference in the
measurements could be attributed to the variability of the
reference points of the measurements and the methods of recording
the arch dimensions. However, in the present study the central
fossae were used as reference points, whereas the distobuccal cusps
were used in both other studies. Hence, meaningful comparisons are
not always possible and firm conclusions are difficult to draw.
The results of the current investigation are of great value to
the anthropologist as well as to the orthodontist in understanding
dimensional arch criteria. For the orthodontist, this can also
assist
with orthodontic arch wire selection. Further, it would be
helpful to the prosthodontist in the selection of the correct shape
and size of stock impression trays and of suitable molds of
artificial teeth for fixed and removable prostheses.
ConclusionThe results of the present study led to the following
conclusions:
1. Mesiodistal tooth width and arch dimen-sions were established
in normal occlusion and malocclusion groups for the sample of the
present study.
2. A significant difference was found between normal occlusion
and malocclusion groups in mesiodistal tooth width. However, no
significant difference was observed in arch dimensions.
3. There was a statistical significant difference in mesiodistal
tooth width between males and females where the males showed
high-er mean values. The same was noticed when arch dimensions were
compared.
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About the Authors
AcknowledgmentsThe authors would like to thank Dr. S. Barakati
for her help in providing the digital caliper and Dr. N. Khan for
carrying out the statistical analysis of the present study.