Maxillary and mandibular mesiodistal tooth sizes among different malocclusions in a

sample of the Turkish population

Sıddık Malkoç Faruk Ayhan Başçiftçi Metin Nur Bülent Çatalbaş

European Journal of Orthodontics, Volume 33, Issue 5, 1 October 2011, Pages 592–596,

http://dergipark.gov.tr/download/article-file/27552

A lot of studies2,10,11 have been performed to evaluate changes in the dental arches but the results of
these studies do not agree with each other, because a number of factors affect dental arch growth.
Researchers12-16 reported that size and form of the dental arch exhibit considerable variability within
and among human groups. Especially there is a marked variation between the dental arches of different
ethnic groups.

In orthodontics, the diagnosis and treatment of malocclusions require accurate knowledge of tooth
dimensions as a stable occlusion is often reliant on the correct intercuspation of the teeth (Andrews,
1972

. Correct space analysis is essential if an optimal occlusion is to be achieved duling orthodontic

treatment (Bishara and Staley, 1984) and the goal of an ideal static and functional occlusion are to be
reached (Andrews, 1972; Roth, 1972).

Several studies have reported tooth size variation between and within different racial groups. Keene
(1971, 1979) reported racial differences in tooth sizes among the American Negroes and their Caucasian
counterparts in caries-free naval recruits. Turner and Richardson (1989) also observed significant
differences in mesio-distal tooth width in Kenyan and Irish populations. In another related study Bishara
et al. (1989) compared the mesio-distal and bucco-lingual crown dimensions of the permanent teeth in
three populations from Egypt, Mexico and the United States. The results from this study indicated
statistically significant differences in the mesio-distal dimension between the three populations. Apart
from racial differences, the other factors associated with tooth size variability are gender (Ghose and
Baghdady, 1979; Lysell and Myrberg, 1982; Bishara et al, 1989), hereditary factors (Townsend and
Brown, 1978), bilateral differences (Ballard, 1944; Lundstrom, 1964), environment (Guagliando, 1982)
and secular changes (Harper, 1994). In Nigerian populations, however, little information is available on
tooth size dimensions (Mack, 1981). The purpose of this investigation was to compare the mesio-distal
and bucco-lingual crown dimensions of a group of Nigerian children to a matched British population
sample.

But Angle, of course, had not contended that this factor alone was enough. Clinical experience and
observations of treatment exhibits at national meetings and elsewhere had increasingly pointed to a
corollary fact— that even with respect to the molar relationship itself, the positioning of that critical
mesiobuccal cusp within that specified space could be inadequate. Too many models displaying that
vital cusp-embrasure relationship had, even after orthodontic treatment, obvious inadequacies, despite
the acceptable molar relationship as described by Angle.

When the mean sums of the arch lengths [Perimeters] were compared using data from all 60
subjects, the arch perimeters of the CD and CIN samples did not differ

It was concluded that total arch lengths [Perimeters] were not significant indicators for crowding.

Gender comparisons: Within the CIN group, males had numerically larger tooth width sums and
arch length sums than females

The sum of maxillary and mandibular tooth widths for CIN’s and CD (both males and females)
mandibular tooth widths for CIN’s and CD (both males and females pooled together and sexes
separately. In the MD stage the mean sum of maxillary and mandibular arch lengths in the MD
were significantly greater than those in the PD, because arch perimeters decrease during the
transition from mixed to permanent dentitions.

In summary, the results of this research thesis study showed that the sum of tooth widths in both
arches had a significant association with dental crowding. In contrast, the sum of arch lengths
[perimeter in both arches] did not differ between the normal and iii crowded samples

In summary, the results of this research thesis study showed that the sum of tooth widths in both
arches had a significant association with dental crowding. In contrast, the sum of arch lengths
[perimeter in both arches] did not differ between the normal and iii crowded samples

Dental crowding can occur with (1) very large teeth with a normal arch perimeter, (2) very large
teeth with a very small arch perimeter, and (3) normal sized teeth with a very small arch
perimeter.

Two thirds of the crowding subjects according to the above combinations have larger than
normal tooth size, and one third have normal size teeth.

When the combinations for crowding are examined by arch perimeter, two thirds of the crowded
patients have small arch perimeters, and one third have a normal size arch perimeter.
These possible combinations are a mixed bag of normal size teeth and large teeth and normal
size arch perimeter and smaller than normal size arch perimeter

Another complication is that the upper and lower arches by themselves also are independent with
3 regard to arch lengths, arch perimeters, arch widths, and tooth sizes.

The polygenic inheritance of the growth and development of the face and dentition is complex.
In addition, the complexity is a statistical challenge!

The past literature about crowding is interesting in that orthodontists have not recognized the
complexity of crowding malocclusions. Orthodontists want to simplify the crowding problem,
but we must accept and deal with the true complexity of crowding problems in order to best
serve our patients that experience crowding.

The following null hypotheses were tested: 1. That the non-crowded and crowded samples do not
differ (are statistically similar) in the maxillary and mandibular arch length segments and in the
maxillary and mandibular arch perimeters (MxAP) (MdAP) in the mixed and permanent
dentitions and in the transition from MD to PD. 2. That the sum of tooth mesio-distal widths
(size) are similar in the noncrowded and crowded samples, that the samples do not differ in
crowding (TSALD) in the MD and PD, and that the samples do not differ in these variables in
the transition from MD to PD. 3. That the sexes do not differ in arch length segments, arch
perimeters, arch widths, tooth size, crowding, and in the transition of these variables from MD to
PD.

Sex differences have been reported by multiple authors in that they all found more dental
crowding in females than in males (La Velle and Foster (1969) Fastlicht (1970) and Foster, et al
(1970). he preceding studies reported that males have 4% larger teeth than females. The greatest
difference was found in the mandibular canines that were 6% larger in males and the least sex
difference was found in the mandibular incisors. These differences were found regardless of
race. Therefore, the preceding studies recommended that in a study of tooth sizes, males and
females should be analyzed separately. Mean mesio-distal tooth size in crowded arches was
uniformly larger than those with non-crowded arches
Hunter and Smith (1972) also found that an orthodontist can expect that crowding in the mixed
dentition will likely result in crowding in the permanent dentition. This is an important landmark
study that described the development and longitudinal growth of crowded malocclusions.

Crowding was defined by Van der Linden (1974) as an inherent discrepancy between tooth size
and the available arch length, mainly of genetic origin

Secondary crowding is caused by environmental factors influencing the dentition, such as caries
and extractions.

Tertiary crowding or late crowding occurs in the post-adolescent period.

A number of other articles have also reported a trend toward increased incidence of mandibular
incisor crowding with higher ages in untreated persons (Barrow, 1952)

According to Moyers (1973) the dental arch is measured through the contact points of the teeth
and represents a series of points where the muscle forces acting against the crowns of the teeth
are balanced.The basal arch, is the arch formed by the corpus mandibularis or maxillaris. Its
dimensions are unaltered by the loss of all permanent teeth and the resorption of the alveolar
processes. The alveolar arch is the arcal measurement of the alveolar process. The dimensions of
the alveolar arch may not coincide with those of the basal arch if the teeth are tipped labially off
the basal arch

Arya (1974) reported that male teeth are consistently numerically larger than female teeth.
Numerical size does not mean statistically larger. Teeth in males were numerically larger than in
females, but not to a statistically significant level. Doris et al (1981) recommended that when the
cumulative tooth mass of the twenty permanent teeth mesial to the first molars is 140 mm or
more, the orthodontist may want to consider extractions

Doris et al (1981) reported that patients that had extractions had consistently larger teeth and a
greater sum of the mesio-distal tooth widths than the group treated by non-extraction.

Doris et al (1981) found that measurements of maxillary and mandibular incisors, canines, and
premolars were uniformly larger in the group with crowded arches. Doris et al(1981) concluded
that an important factor determining whether or not a dental arch will be crowded is the absolute
size of teeth in that arch.
h. Doris (1981) found that crowding increased with age until the thirteenth or fourteenth year and
then tended to decrease.

Howe and McNamara (1983) drew attention to the fact that crowding can result not only from
excessive tooth size, but also inadequate apical bases

McNamara (1983) studied two samples of dental casts from patients in the permanent dentition,
one with gross dental crowding and one with no crowding to determine the extent to which tooth
size and jaw size contribute to dental crowding. .They found that statistically, the crowded and
non-crowded groups could not be distinguished from one another on the basis of mesio-distal
tooth diameters. However, they found significant differences between the dental arch dimensions
of the two samples

The crowded sample was found to have smaller dental arch dimensions than the non-crowded
sample. These results suggested that extra consideration should be given to treatment techniques
that increase dental arch length rather than reduce tooth mass. Howe and McNamara (1983)
introduced a formula to determine whether or not the apical bases of a patient could
accommodate the patient’s teeth in the permanent dentition.

Bishara (1998) studied arch perimeter or circumference measurements that

included the sum of the right and left anterior and posterior segmental arch lengths for the