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Arch Width, Arch Length, And Tooth Size In Young Adult Males Loren F. Mus, D.D.S.* Bethesda, Maryland ‘The problem of malocclusion is re- ceiving great attention by private prac- titioners and public health dentists.* Orthodontists have felt that crowding of teeth may be related to arch width or length, to disproportionately large teeth, or to a combination of factors.*~ ‘The purpose of this preliminary study was to determine if well-aligned dental arches in young adult males differ from crowded dental arches in width, length, or tooth size. If consistent differences could be discovered and defined, they might be useful in formulating plans of treatment and possibly in predicting future needs. MetHops Arch width and length and mesio- distal crown diameters of the right central and lateral incisors in the maxillae and mandibles were measured for volunteer midshipmen at the United States Naval Academy, Annapolis, Md. Two hundred and thirty midshipmen, aged 17-21 years, were selected for study on the basis of neutroclusion of molars without complicating factors, such as cross or open bites, together with a full complement of teeth mesial to the second molar in each jaw. None had a history of orthodontic treatment. ‘The study group was selected from examinations of 524 midshipmen. The decision to measure and allow the right central and lateral incisors in cach arch to represent the tooth size for * U.S. Department of Health, Education, and Welfare, Public Health Service, National Institutes of Health, National Institute of Dental Research, Epidemio- logy and Biometry Branch, Bethesda 14, Maryland, each individual in the group was based on the findings of Seipel’ and a spot check of 100 randomly selected mid- shipmen, (Table 3). Seipel has shown that measurements of mesiodistal crown diameter are not significantly different between the right and left side and a summing up of the entire tooth mate- rial necd not be made. A certain tooth or group of teeth can be selected and, with a reasonable degree of safety, be made to represent the characteristics or specific tooth size of an individual or group of individuals. The men were of mixed European ancestry, from all of the 50 states, and from various socioeconomic _ levels. Naval regulations governing the ad- mission of candidates to the academy state that each applicant be physically sound, well-formed, and of robust constitution, Weight must be in propor- tion to height and general build. The average height and weight for mid- shipmen are 7123 inches and 174+ 20.5 pounds, respectively. These men are above average and are not representative of the usual 17-21 year old American male. Teeth were measured with a Boley gauge. Points of the calipers were filed in order to facilitate measurements in the mouth to the nearest tenth of a millimeter, Width of dental arches was determined by a combination of di viders and sliding scale Helios milli- meter ruler in the canine, first pre- molar, and second premolar regions to the nearest 0.1 mm. Widths of arches in the canine and premolar regions were measured with the dividers from the oe Vol. 34, No. 2 FIGURE 1 Tooth Size sb) Arch length Canine width 1st premolar width ftp- 2nd premolar width DENTAL ARCH WIDTHS AND LENGTHS WERE MEASURED FROM THE REGIONS INDICATED BY THE BROKEN LINES IN THE DIAGRAM Fig. 1 tip of the facial cusp of one premolar, or canine, across the dental arch to the corresponding point on the homologous tooth. The distances between the tips of the dividers were then measured on the Helios ruler. Arch length was meas- ured for the maxilla from a uniform point (Fig. 1) on the mesiolingual sur- face of the first molar to the conjune- tion of mesial surfaces of the central incisors immediately incisal to the pa- pilla. Similarly, mandibular measure- ments were made from first molars to the gingival junction of the central incisors. Left and right segments of each were averaged to obtain length measurements for both maxillae and mandibles. Crowding or malalignment was esti- mated according to the degree of dis- placement of individual teeth from the general configuration of the dental arches. Values of 0, 0.13, 0.25, 0.50, 0.75 or 1.00 were assigned to each tooth mesial to first molars depending upon the relative displacement. These values, illustrated in Figure 2, approximate that fraction of the tooth outside the normal arch line. For example, a score of 0.25 for a maxillary central incisor with a mesiodistal crown diameter of 9.10 mm would indicate that approxi- mately 2.28 mm of the tooth was over- lapped or displaced, Rotated teeth FIGURE 2 ALIGNMENT SCORE Fig. 2 126 Mills April, 1964 TABLE 1 ‘Arch Widths in Region of Ast 2nd Alignment Score Canine Premolar Premolar Arch Length = MAXILLARY ARCH Zero 35.7 42.7 48.7 326 (n= 82) 0.18 - 0.50 35.0 42.0 473 328 (n = 108) : 0.74 - 1.25 35.1 40.8 46.6 32.9 (n= 77) 1,50 - 3.00 348 411 44.7 32.6 (n = 18) S All Men Examined 35.13.20 41.60% .17 47.05.18 32.79 + .20* (n = 230) MANDIBULAR ARCH Zero 26.6 34.5 40.5 268 (n = 82) 0.13 - 0.50 26.3 34.3 39.8 26.8 (n = 103) 0.75 - 1.25 25.9 34.8 39.6 214 (n= 77) a 1.50 - 3.00 23.5 33.8 36.6 26.1 (n = 18) a All Men Examined 26.00+ 15 34.304 .16 39.60.17 26.95 + 32 (n = 280) * Mean and standard error which were not displaced were des nated as zero because tooth space had been maintained. Total alignment score for each individual was the sum of the values assigned to each of his teeth. Individuals with ideal tooth alignment scored zero. Resuurs Average arch widths for the maxilla and mandible in the canine, first pre- molar, and sccond premolar regions were determined according to align- ment scores, (Table 1). Some relation between arch width and alignment score was apparent in each of the six measurements, The most consistent re~ lation was seen in the measurement of the second premolar axis. At this point, the average width of both maxillary and mandibular arches across the sec- ond premolar region steadily decreased in size as malalignment increased in severity. Individuals with an ideal alignment score of zero had dental arches in the second premolar region which were, on the average, approxi- mately four millimeters larger than those with alignment scores ranging from 1.50-3.00. This difference is sta- tistically significant (p < 0.01). None of the 32 persons with ideal tooth alignment measured less than 45 mm across the maxillary second pre- molar region or less than 40.5 mm across the same region in the mandible. Fourteen of the 18 persons (78%) with the most severely crowded teeth Vol. 34, No. 2 Tooth Size TABLE 2 MAXILLARY ARCH Central Lateral Incisor Incisor Total 9.0 6.8 168 9.0 68 158 2 Ca 7 ot 69 16.0 ‘All Men Examined 9.01204 6824.07 15.8321" n= 280 ____ MANDIBULAR ARCH Central Lateral Alignment Score Incisor Incisor Total Zero — 55 59 14 n= 22 0.18 - 0.50 5.5 6.0 15 n= 108 5.5 5.9 114 ee 60 115 n=18 All Men Examined 5.50 + 05, 5.95 + 10 11.45 + .08 n= 230 * Mean and standard error had width measurements in both the maxillary and mandibular second pre- molar regions that were less than 45 mm and 40.5 mm, respectively, while four (22%) had width up to one milli- meter greater than these values. Three- quarters of the individuals (103 out of 135) with almost perfectly aligned teeth, (scores ranging from 0-0.5), had widths of 45 mm or greater in the maxilla and 40.5 mm or greater in the mandible, while three-quarters of the persons (77 out of 95) with alignment scores ranging 0.75-3.00 had widths less than 45 mm and 40.5 mm in the maxilla and mandible, respectively. The use of arch width in the second premolar re- gion to estimate the alignment of teeth would have miscategorized 50 (21.7%) of the midshipmen. Linear regression coefficients were calculated between the arch width measurements across the second pre- molar region and alignment scores for the 230 persons studied. These coeffi- cients indicate the w of change in alignment score for a given unit of change in arch width and were —0.21 + 07 and —0.13 + .04, respectively, in the maxilla and mandible. These in- verse regression coefficients were sta- tistically significant (p < 0.01). No relation was demonstrated be- tween the severity of malalignment and maxillary or mandibular arch length. There was very little difference in 128 TABLE 3 between “0.98 0.78 0.95 0.57 0.55 0.58 0.55 0.56 0.55 0.57 0.56 0.59 0.56 0.52 0.51 mean mesiodistal crown diameters of maxillary and mandibular central and lateral incisors in men with teeth in excellent alignment compared with men with teeth in varying degrees of crowd- ing. These findings are shown in Table 2. Ninety-five per cent of all maxillary central incisors measured between 8.0 and 10.0 in mesiodistal diameter, while ninety-five per cent of maxillary laterals were within the range of 5.5 and 8.0 mm. Range of variation for mandibular incisors was of a similar magnitude. There was a pronounced positive corre- lation of crown diameters of various tooth types within individuals, (Table 3). The results are similar to those of other investigators.* Discussion In this group of men, mean arch width in the second premolar region would have been a good index of group scores for tooth crowding. Excellent alignment would have been predicted for four individuals who actually had severe crowding and for nineteen per- Mills April, 1964 sons whose alignment scores ranged from 0.75-1.25. For these reasons it is doubtful whether width measurements across the second premolar region could be used with confidence in individual cases. However, the present findings do tend to support the suggestion of Howes! that lack of arch width in the premolar area may be an important factor in malalignment. Further testing of this relationship and refinement of the methods appear to be indicated The present findings did not show a relation of tooth size or arch length, mesial to Ma, to alignment. Mesiodistal crown diameter of incisors in this study were similar to the dimensions reported by others" Mean incisor crown diameters did not differ much between persons with high and low alignment scores, The present results were obtained in a unique population of midshipmen selected according to superior standards of health and physical development. The association between alignment of teeth and second premolar arch width should be studied further in more near- ly representative populations, Summary Arch width, arch length, incisor crown diameter, and malalignment scores were determined for 230 young adult males with neutroclusion of mo- lars at the United States Naval Acad- emy, Annapolis, Md. Results indicated a significant association between mal- alignment of teeth and arch width. Arch length mesial to Mz and incisor crown diameter did not vary in persons with and without malalignment. ACKNOWLEDGMENTS Gratitude is expressed to the United States Navy Dental Service, especially to Captains William R. ‘Stanmeyer, Kenneth Longeway, Paul Moore, and Lt. F. M. Richardson’ for their assistance and cooperation. Vol. 34, No. 2 Angle's molar classification and the other characteristics of malocclusion were determined independently by Dr. Peter J. Coccaro, Oral Pharyngeal De- velopment Section, Oral Medicine and Surgery Branch, National Institute of Dental Research. BIBLIOGRAPHY 1. Barber, T. K, and Renfroe, E. Q.: Interceptive Orthodontics for the General Practitioner, J. Am. Dent. A., 54: 828-846, Mar. 1957, 2, Baume, L. F.:’ Physiological Tooth Migration and Its Significance for Development of Occlusion, J. D. Res. 29: 338-348, June 1950. 3. Horowitz, S. L., et al: Hereditary Factors in Tooth Dimensions, a Study of the Anterior ‘Teeth in Twins, Angle Ortho., 28: 87-93, Apr. 1958, 4. Howes, A. E.: Arch Width in the Tooth Size 129 Premolar Region — Still the Major Problem in Orthodontics, Am.” J. Ortho. 48: 5-31 Jan., 1957. . Moorrees, C. F, A. and Reed, R. B.: Biometrics of Crowding and Spacing of the Teeth in the Mandible, Am. J. Phys. Anthro. 77-88, Mar.'1954. Jackson, Andrew F.: The Science, Philosophy, and Art of Orthodontic Practice, Am. J. Ortho., 44: 754-790, Oct, 1958. Lundstrom, Anders: The Signifi- cance of Early Loss of Deciduous Teeth in the Etiology of Malocclu- sion, Am. J. Ortho., page 819, Nov. 1955. Seipel, C. M.: Variation of Tooth Position, ‘pp. 53-54, Svensk Tandla- kara, Suppl. 89, 1946. Sicher, Harry:’ Oval Anatomy, St. Louis 1954, The C. V. Mosby Co. Wheeler, R. C.: A ‘Text Book of Dental 'Anatomy and Physiology, Phil. & London, 1950, W. B. Saun- ders Co.

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