Download comparison of dental and alveolar arch widths in class i and class ii

Comparison of dental and alveolar arch widths
ORTHODONTICS
ORIGINAL ARTICLE
COMPARISON OF DENTAL AND ALVEOLAR ARCH WIDTHS IN CLASS I
AND CLASS II DIVISION 1 MALOCCLUSION
NADIA BHUTTA, BDS, FCPS
JUNAID ISRAR BDS, DDCS, MFDS RCSENG, FCPS (Orth)
3
ABIDA IJAZ BDS, D.Orth, MCPS, MS, FPFA, FICD
1
2
ABSTRACT
The objective of this study was to compare transverse dimensions of the dental arches and
alveolar arches in the canine, premolar and molar regions of Class I and Class II div 1 malocclusion
groups. This cross sectional study was performed at Lahore medical and dental college, from January
2011 to November 2011, using measurements on dental casts of 30 Class I and Class II div 1 adult
female subjects. Twelve dental and alveolar arch width measurements were recorded from dental casts
using a dial caliper. Descriptive analysis and paired sample t- test were carried out for significance
(P < 0.05). Statistically significant differences were found in two of the twelve measurements.
Mandibular canine alveolar width & mandibular premolar alveolar width in Class II div1 group were
significantly narrower than Class I group. Rest of the variables did not show any significant
difference. The results of our study suggest that Mandibular intercanine and interpremolar alveolar
width measurements were narrower in Class II subjects and there is a tendency towards lingual cross
bites in that malocclusion group.
Key Word: Dental arch width, Alveolar arch width, Class I malocclusion, Class II div 1 malocclusion.
INTRODUCTION
Improving patient esthetics is one of the main
goals of orthodontic treatment. This cannot be achieved
without thorough diagnosis of the case. Orthodontic
diagnosis involves investigations of the face in all
three dimensions both clinically and radiographically.
Intra oral and extra oral measurement of face and
dental arches is a routine procedure during orthodontic diagnosis.
1
2
3
Assistant Professor, Orthodontic Department Lahore Medical &
Dental College, Lahore.
Assistant Professor, Orthodontic Department Lahore Medical &
Dental College, Lahore.
Professor & Head of Orthodontic Department Faryal Dental
College, Faizpur Interchange
Corresponding Author and Reprint request to:
Dr. Junaid Israr
SD 39, Street 3, Block 2, Askari III Officers Colony,
Bedian Road, Lahore Cantt. Lahore. 54792
Tel No: 0322-4729367
E-mail: [email protected] www.orthozone.pk
Mobile: 00962-777515170
Received for Publication:
Accepted:
July 8, 2013
July 16, 2013
Pakistan Oral & Dental Journal Vol 33, No. 2 (August 2013)
The size and shape of the arches have significant
implications in orthodontic diagnosis and treatment
planning, affecting the space available, dental esthetics, and stability of the dentition1. Arch width has been
a subject of interest among investigators studying the
growth of arches.4-8
Transverse component of growth is of great importance as it is the first dimension in which growth
ceases.2 Arch width dimensions in addition to causing
transverse discrepancies also contribute to anteroposterior and vertical plane malocclusions.
Class II malocclusion is reported as the most
frequently seen skeletal disharmony in orthodontic
population.13-19 Graber reported that many class II
malocclusions have a strong transverse component in
addition to sagittal and vertical problems.3 Transverse
component of skeletal Class II patients has considerable importance while planning and executing treatment of these individuals.
289
Comparison of dental and alveolar arch widths
In search of etiology and treatment planning in
different malocclusions, various studies have been
conducted to compare widths of adult subjects with
normal occlusion to those of different malocclusion
samples.4-12 However, there is considerable controversy among the results presented in the literature.
Some of the authors evaluating transverse dimensions had reported that maxillary arch was narrower
in patients with Class II, division 1 malocclusion, and
an expansion was needed during or before
treatment.20-24
Review of literature in this regard indicates that
knowledge of dental arch and dentoalveolar width
associated with class I and Class II, Division 1 malocclusion would be helpful to establish a good differential
diagnosis in order to adopt the treatment that will
achieve the greatest efficiency and the most stable
results possible.
Skeletal constriction, dentoalveolar constriction
and dental constriction must therefore be differentiated, as each requires different treatment with different orthodontic appliances.
The aim of this study was to find possible dental
and alveolar transverse differences between class II
div I and Class I malocclusion. This study will aid in
diagnosis of the possible site & cause of arch constriction. The resulting information could help determine
the mode of expansion to be planned for a typical
malocclusion.
METHODOLOGY
This study was conducted at department of orthodontics, Lahore medical and dental college. The study
was performed using initial lateral cephalograms and
60 dental casts (30 Class I malocclusion and 30 class II
div 1 malocclusion) female patients that reported to
department of orthodontics from January 2011 to
November 2011. Age of the subjects ranged from 16-25
years. The mean and standard deviations of ages of
class I and class II patients were 20.9 + 2.58 and 21.2
+ 2.14 years respectively. All subjects had adult dentition and none of them had undergone orthodontic
treatment previously. A total of twelve dental and
alveolar arch width measurements were recorded to
the nearest 0.1 mm from each patient’s dental casts
using a dial caliper. Following criteria was used:
Pakistan Oral & Dental Journal Vol 33, No. 2 (August 2013)
CLASS I MALOCCLUSION SAMPLE
Dental casts of 30 adult female with Class I malocclusion were selected. All subjects were skeletally
class I, as diagnosed with the help of lateral
cephalograms and had bilateral class I canine & molar
relationship, all permanent teeth from first molar to
first molar fully erupted and present, no ectopic eruptions, no anterior and posterior cross bites, no impactions, good facial symmetry determined clinically, mild
to moderate crowding in either or both arches and no
history of trauma.
CLASS II MALOCCLUSION SAMPLE
Dental casts of 30 adult females with class II div I
malocclusion were selected. All subjects were skeletally class II div 1 as determined by lateral cephalograms and had bilateral class II canine & molar relationship, excessive overjet (more than 5mm), all permanent teeth from first molar to first molar fully
erupted and present, no ectopic eruptions, no anterior
and posterior cross bites, no impactions, good facial
symmetry determined clinically, mild to moderate
crowding in either or both arches and no history of
trauma.
The landmarks on the casts that were used in this
study are shown in Figure 1 & 2 and explained in
Table 1.
RESULTS
Four weeks after the first measurements, a second
set of measurements was done. Method error was
calculated and found to be negligible. Descriptive statistics (Minimum, Maximum, Mean Standard deviation) and statistical comparisons of dental & alveolar
width measurements for dental casts of the two groups
identified (Class I & Class II Div 1) are shown in Table
2, 3, & 4. Statistically significant differences were
found in two of the twelve measurements. Mandibular
canine alveolar width in Class II was significantly
narrower than Class I subjects (P < .005). Similarly,
mandibular premolar alveolar width was significantly
narrower in Class II subjects as compared to Class I (P
< .05). Rest of the variables did not show any significant difference.
290
Comparison of dental and alveolar arch widths
DISCUSSION
This study was carried out to compare the dental
arch and alveolar base widths of Class I and Class II
div1 malocclusion patients. Width measurements described in this article will help clinicians diagnose and
plan the treatment of patients with Class I and Class
II division 1 malocclusions and to device expansion
protocols for the target area.
Investigators who studied growth changes in the
transverse arch width found that molar and canine
arch widths did not change after age 13 in female
subjects and age 16 in male subjects.25-28
Inter canine width has been of particular interest
to the researchers who have been working on transverse width measurements of dental arches.6,7,8,22,35 In
TABLE 1: MAXILLARY AND MANDIBULAR DENTAL AND ALVEOLAR WIDTH MEASUREMENTS
USED IN THE STUDY
Abbreviation
Explanation
UC-C
Distance between cusp tip of right and left canines OR the centre of wear facets in cases of
attrition.
Distance between two points at the mucogingival junctions above the cusp tips of the
maxillary right and left canines.
Distance between cusp tip of right and left 1st premolars OR the centre of wear facets in cases
of attrition.
Distance between two points at the mucogingival junctions above the Interdental contact
point of the maxillary first and second premolars.
Distance between mesiobuccal cusp tip of right and left 1st molars OR the centre of wear
facets in cases of attrition.
Distance between two points at the mucogingival junctions above the mesio buccal cusp tips
of the maxillary right and left 1st molars.
Distance between cusp tip of right and left canines OR the centre of wear facets in cases of
attrition.
The projection of UAC-C point in lower arch.
Distance between cusp tip of right and left 1st premolars OR the centre of wear facets in cases
of attrition.
The projection of UAP-P point in lower arch.
Distance between most gingival extensions of buccal grooves on the right and left 1st molars.
The projection of UAM-M point in lower arch.
UAC-C
UP-P
UAP-P
UM-M
UAM-M
LC-C
LAC-C
LP-P
LAP-P
LM-M
LAM-M
TABLE 2: DESCRIPTIVE ANALYSIS CLASS I
Variables
N
Minimum
Maximum
Mean
Std. Dev
UCC
UACC
UPP
UAPP
UMM
UAMM
LCC
LACC
LPP
LAPP
LMM
LAMM
30
30
30
30
30
30
30
30
30
30
30
30
30.00
31.00
31.00
40.00
38.00
52.00
20.00
29.50
25.00
39.00
44.00
50.00
40.00
42.00
49.50
54.00
54.50
61.00
31.00
48.00
42.00
49.50
59.50
61.00
34.0667
36.0333
40.2500
47.4000
50.2000
56.0167
26.4500
34.3000
33.8167
45.3167
50.0833
54.8833
2.39516
2.90046
3.56649
3.37179
2.94373
2.23793
2.51324
3.42053
3.10029
2.63427
3.26972
2.82136
Pakistan Oral & Dental Journal Vol 33, No. 2 (August 2013)
291
Comparison of dental and alveolar arch widths
TABLE 3: DESCRIPTIVE ANALYSIS CLASS II
Variables
N
Minimum
Maximum
Mean
Std Dev
UCC
UACC
UPP
UAPP
UMM
UAMM
LCC
LACC
LPP
LAPP
LMM
LAMM
30
30
30
30
30
30
30
30
30
30
30
30
29.00
34.00
35.00
45.00
42.00
51.50
22.00
26.00
29.50
31.00
47.00
49.50
42.50
44.00
47.00
56.00
57.00
66.00
31.00
44.00
41.00
51.00
60.00
64.00
34.4167
37.2500
39.7167
48.4833
50.4833
56.9000
26.3500
31.5333
33.6667
43.4000
50.9000
53.6833
2.68804
2.67411
3.14775
2.87823
3.42527
3.58252
2.34576
3.66938
2.80803
3.64692
3.50714
3.31788
TABLE 4: PAIRED SAMPLES STATISTICS
Paired Variable
Mean
N
Std Dev
Std Error
Significance
UCC1UCC2
UACC1UACC2
UPP1UPP2
UAPP1UAPP2
UMM1UMM2
UAMM1UAMM2
LCC1LCC2
LACC1LACC2
34.066734.4167
36.033337.2500
40.250039.7167
47.400048.4833
50.200050.4833
56.016756.9000
26.450026.3500
34.300031.5333
30
30
30
30
30
30
30
30
2.395162.68804
2.900462.67411
3.566493.14775
3.371792.87823
2.943733.42527
2.237933.58252
2.513242.34576
3.420533.66938
.43729.49077
.52955.48822
.65115.57470
.61560.52549
.53745.62537
.40859.65408
.45885.42828
.62450.66993
.599
.111
.517
.204
.724
.215
.868
.005**
LPP1LPP2
LAPP1LAPP2
LMM1LMM2
LAMM1LAMM2
33.816733.6667
45.316743.4000
50.083350.9000
54.883353.6833
30
30
30
30
3.100292.80803
2.634273.64692
3.269723.50714
2.821363.31788
.56603.51267
.48095.66583
.59697.64031
.51511.60576
.838
.031*
.358
.090
UAP-P
LAP-P
UAC-C
LAC-C
LC-C
UC-C
LP-P
UP-P
UM-M
UAM-M
LM-M
LAM-M
Fig 1: Maxillary dental cast measurements (modified from Uysal, Memili, Usumez, Sari)
Fig 2: Mandibular dental cast measurements (modified from Uysal, Memili, Usumez, Sari)
Pakistan Oral & Dental Journal Vol 33, No. 2 (August 2013)
292
Comparison of dental and alveolar arch widths
our study, when we compared the intercanine widths
of class I and class II div I malocclusion patients, it was
found that mandibular canine alveolar width in Class
II was significantly narrower than Class I subjects (P
< .005). Similarly, mandibular premolar alveolar width
was significantly narrower in Class II subjects as
compared to Class I (P < .05).
These results were in accordance with the work
done by Uysal T et al35 who concluded that that mandibular intercanine and interpremolar widths were narrower in class II div I individuals.
However, our results did not match other studies
such as Fröhlich6, who compared intercanine widths of
both arches from 51 children with Class II malocclusion from data collected by Moorrees11 of children with
normal occlusion and found that absolute arch widths
of the Class II children did not differ appreciably from
those of children with normal occlusion.
Sayin and Turkkahraman7 concluded that mandibular intercanine widths were significantly larger in
Class II, division 1 group than Class I group, whereas
no significant differences were found between maxillary canine width measurements of the two groups.
They further found no differences between groups in
maxillary and mandibular interpremolar widths.
Intermolar widths are the most commonly evaluated measurement in previous studies.30,31,32 In our
study, we did not find any significant differences of
maxillary and mandibular intermolar dental and alveolar widths in the two population samples. This
result was in accordance to Fröhlich6 who found no
difference in molar widths between normal and Class
II subjects. Bishara et al20 found no significant differences in the female comparisons of the intermolar
width measurements.
Staley et al8 reported that subjects with normal
occlusion (Class I) had larger maxillary and mandibular intermolar width differences than subjects with
malocclusion. While evaluating alveolar widths, they
reported that maxillary alveolar widths and mandibular alveolar widths of the males were larger in the
Class I group.
siobuccal cusp tips & central fossa respectively) were
significantly larger in Class I group than Class II,
division 1 group (P, .01). However, mandibular
intermolar widths I and II (from left and right mesiobuccal & distobuccal cusp tips respectively) did not
differ significantly between groups.
Slaj M et al29 in their study on virtual 3D models
concluded that the dimensions of the dental arches are
related to gender and to dentoalveolar class. Class I
and II subjects have similar dimensions of maxillary
dental arch, but Class II subjects have a transverse
deficit in the mandible.
Different suggestions have been put forth in literature to treat the transverse deficiencies of various
malocclusions depending on the etiology. Sayin and
Turkkahraman7 concluded that transverse discrepancy in Class II division 1 patients originated from
upper posterior teeth and not from the maxillary
alveolar base, therefore, they suggested slow maxillary expansion rather than rapid maxillary expansion
may be considered before or during the treatment of
Class II division 1 patients.
Interestingly, Uysal T35 suggested quite the opposite i.e., the maxillary molar teeth in subjects with
Class II division 1 malocclusions tend to incline to the
buccal to compensate for the insufficient alveolar base.
For that reason, rapid maxillary expansion rather
than slow expansion may be considered before or
during the treatment of Class II division 1 patient.
Our study was unable to find any significant difference in the two comparative groups. Dental and
alveolar widths in the maxillary canine, premolar and
molar regions were insignificantly different form one
another.
CONCLUSION
According to Sayin and Turkkahraman7 maxillary
intermolar widths I and II (from left and right me-
It was concluded from this study that no dental
and alveolar differences exist between the two malocclusion samples except that the mandibular intercanine
and inter premolar alveolar widths are significantly
narrower in class II samples. The variation in results
in our study sample can be attributed to ethnic differences. As a recommendation, we suggest that in Pakistani populations the expansion of maxillary arches in
the class II div I groups can be done by any appliance
Pakistan Oral & Dental Journal Vol 33, No. 2 (August 2013)
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Comparison of dental and alveolar arch widths
depending on the severity of the initial situation and
proper diagnosis of the case.
19
Lauc T. Orofacial analysis on the Adriatic islands: an epidemiological study of malocclusions on Hvar Island. Eur J Orthod.
2003; 25: 273-278.
REFERENCES
20
Bishara SE, Bayati P, Jakobsen JR. Longitudinal comparisons
of dental arch changes in normal and untreated Class II,
division 1 subjects and their clinical implications. Am J Orthod
Dentofacial Orthop. 1996; 110: 483-489.
21
Tollaro I, Baccetti T, Franchi L, Tanesescu CD. Role of posterior
transverse interarch discrepancy in Class II, division 1 malocclusion during the mixed dentition phase. Am J Orthod
Dentofacial Orthop. 1996; 110: 417-422.
22
Baccetti T, Franchi L, McNamara JA Jr, Tollaro I. Early
dentofacial features of Class II malocclusion: a longitudinal
study from the deciduous through the mixed dentition. Am J
Orthod Dentofacial Orthop. 1997; 11: 502-509.
23
McNamara JA Jr, Brudon WL, Kokich VG. Orthodontics and
Dentofacial Orthopedics. Ann Arbor, Mich: Needham Press;
2001: 63-84.
24
McNamara JA Jr. Early intervention in the transverse dimension: is it worth the effort? Am J Orthod Dentofacial Orthop.
2002; 121: 572-574.
25
Staley RN, Stuntz WR, Peterson LC. A comparison of arch
widths in adults with normal occlusion and adults with Class II
division 1 malocclusion. Am J Orthod. 1985; 88: 163-169.
Knott VB. Size and form of the dental arches in children with
good occlusion studied longitudinally from age 9 years to late
adolescence. Am J Phys Anthropol. 1961; 19: 263-284.
26
9
Enlow DH, Hans MG. Essentials of Facial Growth. Philadelphia, Pa: WB Saunders; 1996: 1-280.
Knott VB. Longitudinal study of dental arch widths at four
stages of dentition. Angle Orthod. 1972; 42: 387-394.
27
10
Buschang PH, Stroud J, Alexander RG. Differences in dental
arch morphology among adult females with untreated Class I
and Class II malocclusion. Eur J Orthod. 1994; 16: 47-52.
DeKock WH. Dental arch depth and width studied longitudinally from 12 years of age to adulthood. Am J Orthod. 1972; 62:
56-66.
28
Moorrees CFA, Gron AM, Lebret LML, Yen PKJ, Fröhlich FJ.
Growth studies of the dentition: a review. Am J Orthod. 1969;
55: 600-616.
Sillman JH. Dimensional changes of the dental arches: longitudinal study from birth to 25 years. Am J Orthod. 1964; 50:
824-842.
29
Walkow TM, Peck S. Dental arch width in Class II division2
deep-bite malocclusion. Am J Orthod Dentofacial Orthop. 2002;
122: 608-613.
Slaj M, Spalj S, Pavlin D, Illes D, Slaj M. Dental arch forms in
dentoalveolar Class I, II and III. Angle Orthod. 2010; 80:
919-924.
30
Ast DB, Carlos JP, Cons DC. Prevalence and characteristics of
malocclusion among senior high school students in up-state
New York. Am J Orthod. 1965; 51: 437-445.
Filho OG, JÚnior FM, Ozawa TO. Dental arch dimensions in
class II division 1 malocclusions with mandibular deficiency.
Angle Orthod. 2008; 78(3): 307-89.
31
Rasool G, Kundi I. Comparison of dental arch dimensions
among various malocclusion classes. J. Med. Sci. 2009; 17(2):
71-77.
32
Lux CJ, Conradt C, Burden D, Komposch G. Dental arch widths
and mandibular-maxillary base widths in class II malocclusions
between early mixed and permanent dentitions. Angle Orthod.
2003; 73: 674-685.
33
Moorrees CFA. The Dentition of the growing child. Cambridge,
Mass: Harvard University Press; 1959: 87-110.
34
Varella J. Early developmental traits in Class II malocclusion.
Acta Odontol Scand. 1998; 56: 375-377.
35
Uysal T, Memili B, Usumez S, and Sari Z. Dental and alveolar
arch widths in normal occlusion, class II division 1 and Class II
division 2. Angle Orthod. 2005; 75(6): 941-947.
1
Lee RT. Arch width and form: a review. Am J Orthod Dentofacial
Orthop. 1999; 115: 305-313.
2
Proffit WR, White RP, Sarver DM. Contemporary treatment of
dentofacial deformity. 4th ed. St Louis: Mosby, 2005: 113.t
3
Graber TM, Vanarsdall RL Jr, Vig Katherine WL. : Current
principles and techniques. 4th ed. St Louis: Mosby, 2005: 554.
4
Solow B. The pattern of craniofacial associations. Acta Odontol
Scand. 1966; 24: 46.
5
Slagsvold O. Associations in width dimensions of the upper and
lower jaws. Trans Eur Orthod Soc. 1971; 43: 465-471.
6
Fröhlich FJ. A longitudinal study of untreated Class II type
malocclusion. Trans Eur Orthod Soc. 1961; 37: 137-159.
7
Sayin MO, Turkkahraman H. Comparison of dental arch and
alveolar widths of patients with Class II division 1 malocclusion
and subjects with Class I ideal occlusion. Angle Orthod. 2004;
74: 356-360.
8
11
12
13
14
Moyers RE. Handbook of Orthodontics. Chicago, Ill: Year Book
Med Publishers; 1988: 191.
15
Burgersdijk R, Truin GJ, Frankenmolen F, Kalsbeek H, van’t
Hof M, Mulder J. Malocclusion and orthodontic treatment need
of 15- 74-year-old Dutch adults. Community Dent Oral Epidemiol. 1991; 19: 64-67.
16
Tang EL. The prevalence of malocclusion amongst Hong Kong
male dental students. Br J Orthod. 1994; 21: 57-63.
17
Willems G, De Bruyne I, Verdonck A, Fieuws S, Carels C.
Prevalence of dentofacial characteristics in a Belgian orthodontic population. Clin Oral Investig. 2001; 5: 220-226.
18
Silva RG, Kang DS. Prevalence of malocclusion among Latino
adolescents. Am J Orthod Dentofacial Orthop. 2001; 119:
313-315.
Pakistan Oral & Dental Journal Vol 33, No. 2 (August 2013)
294