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Journal of International Oral Health 2016; 8(5):626-628
Bolton discrepancy… Hantodkar NV et al
Received: 09th December 2015 Accepted: 06th March 2016 Conflicts of Interest: None
Case Report
Source of Support: Nil
Doi: 10.2047/jioh-08-05-20
Management of Bolton Discrepancy in Peg-shaped Tooth
N V Hantodkar1, Amol A Verulkar2, Anand Tripathi2, Anukool Pateria3, Swapnil B Wankhade3, Rinku Advani3
Contributors:
1
Professor and Head, Department of Orthodontics and Dentofacial
Orthopedics, VYWS Dental College, Amravati, Maharashtra, India;
2
Associate Professor, Department of Orthodontics and Dentofacial
Orthopedics, VYWS Dental College, Amravati, Maharashtra, India;
3
Senior Lecturer, Department of Orthodontics and Dentofacial
Orthopedics, VYWS Dental College, Amravati, Maharashtra, India.
Correspondence:
Dr. Hantodkar NV. Department of Orthodontics and Dentofacial
Orthopedics, VYWS Dental College, Tapovan, Wadali Road Camp,
Amravati, Maharashtra, India. Email: [email protected]
How to cite the article:
Hantodkar NV, Verulkar AA, Tripathi A, Pateria A, Wankhade SB,
Advani R. Management of bolton discrepancy in peg-shaped tooth.
J Int Oral Health 2016;8(5):626-628.
Abstract:
Orthodontic treatment comprises different phases with unique
characteristics and challenges. Tooth size discrepancies are
considered an important variable, especially in the anterior segment.
Orthodontic treatment of a patient with peg-shaped lateral incisor
becomes difficult due to problem encounter during bonding of
orthodontic bracket on the malformed tooth. Maintaining midline
and space for final restoration on peg-shaped lateral incisor during
orthodontic treatment is mostly done using coil spring which is less
efficient, tedious, and uncomfortable to the patient. This article
presents a new method of management of Bolton discrepancy due
to peg-shaped lateral in conjunction with temporary prosthetic
pontic by the orthodontic method.
anterior teeth with deep bite and peg-shaped right lateral incisor.
The treatment of the patient began with the good working
model impression of the patient. On working model, actual
Bolton discrepancy was calculate using Bolton’s Formula.2
Wax pattern was prepared for temporary prosthetic pontic of
the peg-shaped tooth by adding calculated Bolton discrepancy
(by Bolton’s formula) (Figure 2a and b) and temporary prepare
prosthetic pontic was prepared (Figure 3a and b). Bonding
in the maxillary arch was done with 0.018 MBT except on
peg-shaped right maxillary lateral incisor (Figure 4a and b).
A good working model impression was taken after bonding
orthodontic brackets and a good second working model was
prepared. Temporary pontic was placed on the peg-shaped
tooth,3,4 and bracket was bonded on temporary pontic on
the second working model (according to other brackets of
arch). Temporary pontic with bonded bracket was cement
on peg-shaped tooth in patient’s oral cavity (Figure 5a-c).
Orthodontic treatment was continued for period of 6 months
(Figure 6a-c), and final ceramic restoration was given after
complete orthodontic treatment (Figure 7).5-7
Key Words: Bolton discrepancy, peg-shaped lateral incisor, pontic
Introduction
Cooperation, coordination, and interaction between different
specialties in dentistry are extremely important in establishing
diagnosis and treatment planning. The interaction between the
different disciplines is necessary, and in some cases, it is crucial
in facilitating coordinated dental therapy. The interrelationship
between orthodontics and prosthodontics often resembles
symbiosis. Andrew1 gives six keys of normal occlusion, and
the Bolton2 ratio is one of the important factors for normal
occlusion. In peg-shaped tooth, there is a Bolton discrepancy.
This article presents a new method of management of Bolton
discrepancy in conjunction with temporary prosthetic pontic
by orthodontic method.
Figure 1: Patient with peg-shaped upper right lateral.
a
b
Figure 2: (a) Wax pattern for temporary prosthetic pontic by
adding calculated Bolton discrepancy (by Bolton’s formulae)
(front view). (b) Wax pattern for temporary prosthetic
pontic by adding calculated Bolton discrepancy (by Bolton’s
formulae) (lateral view).
Case Report
This paper reports a case of 23-year-old man, who reported
with a chief complaint of spacing in the anterior maxillary
region (Figure 1). An intraoral examination showed spacing in
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Journal of International Oral Health 2016; 8(5):626-628
Bolton discrepancy… Hantodkar NV et al
a
b
a
Figure 3: (a) Temporary pontic on peg-shaped tooth with
bracket according to other brackets of arch (occlusal view).
(b) Temporary pontic on peg-shaped tooth with bracket
according to other brackets of arch (frontal view).
b
c
a
Figure 6: (a) Patient during fixed orthodontic treatment
(extraoral view). (b) Intraoral frontal view of patient.
(c) Intraoral lateral view of patient.
b
Figure 4: (a) Patient before cement the temporary pontic with
bracket on peg-shaped tooth (frontal view). (b) Patient before
cement the temporary pontic with bracket on peg-shaped tooth
(lateral view).
a
b
c
d
a
Figure 7: (a-d) Patient after debonding of fixed orthodontic
appliance and permanent restoration with peg-shaped lateral
incisor (Intraoral view).
b
and create a proper space for a normal sized lateral incisor and
restorative dentist has to build up.4-7 The peg-lateral to simulate
a normal sized lateral incisor.
The position of the peg lateral within space is more important
and that will depend on the actual size and shape of the peg
lateral and amount of available space that can create for the
lateral incisor tooth. The creation of space and management
of malposition of the peg-shaped tooth is depending on
orthodontic treatment. Orthodontic treatment of the patient
with peg-shaped lateral incisor becomes difficult due to
problem encounter during bonding of orthodontic bracket on
the malformed tooth. Maintaining midline and space for final
restoration on peg-shaped lateral incisor during orthodontic
treatment is mostly done using coil spring which is less efficient,
tedious, and uncomfortable to the patient. The present method
is a comparatively good method for space maintaining than coil
spring and for maintaining midline coinciding. This method
is excellent regarding the esthetic point of view because it is
possible to maintain exact space for the final restoration and
patient get esthetic temporary prosthetic crown in between
treatment. This method helps in correction of individual
malocclusion of the peg-shaped tooth such as tipping, rotation,
intrusion, and extrusion.
c
Figure 5: (a) Patient after cementation (extraoral view).
(b) Patient after cementation of the temporary pontic with
bracket on peg-shaped tooth (frontal view). (c) Patient after
cementation of the temporary pontic with bracket on pegshaped tooth (lateral view).
Discussion
This article presents a new method of management of Bolton2
discrepancy in conjunction with temporary prosthetic
pontic by orthodontic method. Tooth size discrepancies are
considered an important variable, especially in the anterior
segment. There are several treatment options to consider
for peg-shaped laterals. Counihan (2000) recommends that
there are two basic approaches. First, the lateral incisor can be
extracted and resultant space closed. However, this will often
give a narrow unaesthetic smile. The second, preferred option
is often to open the space mesial and distal to the peg lateral
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Journal of International Oral Health 2016; 8(5):626-628
Bolton discrepancy… Hantodkar NV et al
Conclusion
This is a comparatively good method for maintaining midline
coinciding and space maintaining than coil spring. By this
method exact space maintaining for the final restoration is
possible, and it is possible to correct individual malocclusion
of the peg-shaped tooth such as tipping, rotation, intrusion,
and extrusion because it is easy to bond bracket on temporary
pontic than normal peg-shaped tooth.
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References
1. Andrews LF. The six keys to normal occlusion. Am J
Orthod 1972;62(3):296-309.
2. Bolton WA. Disharmony in tooth size and its relation to
the analysis and the treatment of occlusion. Angle Orthod
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