COMPARISON OF TWO NON-RADIOGRAPHIC TECHNIQUES OF MIXED DENTITION ANALYSIS AND EVALUATION OF THEIR APPLICABILITY FOR MARATHI POPULATION

Sushma Sonawane1, Asha Bettigiri2, Vivek P. Soni3

Abstract
Mixed dentition arch analysis is an important criterion in determining whether the orthodontic treatment plan is going to involve serial extraction, guidance of eruption, space maintenance, space regaining or just periodic observation of the patient. The determination of tooth size arch length discrepancy in the mixed dentition requires an accurate prediction of the mesiodistal width of the unerupted permanent teeth.

Introduction
Mixed dentition arch analysis is an important criterion in determining whether the orthodontic treatment plan is going to involve serial extraction, guidance of eruption, space maintenance, space regaining or just periodic observation of the patient. The determination of tooth size arch length discrepancy in the mixed dentition requires an accurate prediction of the mesiodistal width of the unerupted permanent teeth. Various approaches have been applied to estimate the mesiodistal crown widths of unerupted maxillary and mandibular canines and premolars in mixed dentition patients. Commonly applied are: 1. Measurement of the unerupted teeth on radiographs1 , Moyers equation does not mention the population group from which they were calculated, and prediction equations derived by Tanaka and Johnston2 is based on data derived from Northern European Ancestry. Therefore the accuracy of these prediction methods could possibly in question when applied to a population of different ethnic origin. Therefore, present study was undertaken to examine and compare the accuracy of the Moyers and Tanaka Johnston mixed dentition analyses and to evaluate its applicability to Indian Marathi population.

Sample collection
Finally, the 110 patients study models collected were the representative occlusions of 55 males and 55 females between the age group of 13 to 18 years. Further the candidates all satisfied the following criteria :1) Candidate had to be of Maharashtrian background for at least three prior generations and should have had marathi as a mother tongue. 2 ) Candidate should have resided in Maharashtra since three prior generations. 3) All subjects gave no history of past orthodontic treatment of any kind.

2. Use of a regression equation that relates the width of erupted teeth to the widths of unerupted teeth2,5. 3. A combination of measurements from the erupted teeth and from radiographs of unerupted teeth3. Statistical methods employing linear regression equations were first used by Moyer5 and results were published in the form of the well known Prediction tables in his textbook in 1958.
Reader , Professor , Professor & HOD Dept of Orthodontics, Dr. D. Y. Patil Dental College & Hospital, Navi Mumbai
1 2 3

Scientific Journal

Vol. II - 2008

Two Non-radiographic Techniques of Mixed Dentition Analysis and Evaluation .. Sushma Sonawane

Dental Criteria
Dental criteria included the following. Dental casts must have had fully erupted permanent mandibular incisors and permanent mandibular and maxillary canines and premolars. 1. Dental cast had to be of high quality and free of distortions. 2. The teeth measured had to be free of restorations, fractures, or proximal caries as determined by bitewing radiographs and the dental casts. 3. There had to be no evidence of hypoplasia or anomalous form to the teeth being measured and 4. Maximum 18 years of age was used to preclude any discrepancies based on significant proximal wear.

Mesiodistal diameter of unerupted maxillary and mandibular canine and first and second premolars were calculated according to Tanaka Johnstons approach by adding 10.5 mm and 11 mm to half the total width of the mandibular four incisors respectively. The results were subjected to statistical analysis.

Statistical analysis
Descriptive statistics including the mean, standard deviation, and minimum and maximum values were calculated for the predictive tooth size as well as actual tooth size. Unpaired t tests were used to determine whether significant differences were present in the mesiodistal tooth size on right and left side as well as in male subjects and females subjects. Correlation coefficient r was performed between the predicted and actual tooth size obtained by both the prediction methods. In order to determine the extent to which sum of maxillary and mandibular canine, first premolar and second premolar varies as the sum of four mandibular incisors increases or decreases, the coefficient of correlation were calculated.

Measurement of mesiodistal width of crown

a) The mesiodistal crown diameter of permanent mandibular incisors, mandibular and maxillary canines and premolars were measured by using a digital caliper accurate to 0.01mm (Mitutoyo Corporation, Tokyo, Japan) as given by priest4. b) Methods of measurements of mesiodistal width: The mesiodistal diameter of a teeth was obtained by measuring the greatest distance between the contact points on its proximal surfaces using a sliding caliper held parallel to both the occlusal and vestibular surface. This procedure was employed when teeth were in a normal position in the dental arch. Other wise the mesiodistal diameter of crown was obtained by measuring between the points where contact with neighboring teeth normally should occur. In case of linguoversion, a lingual insertion was used. Since the widest portion of a tooth is usually toward the buccal, it follows that the measurement from contact point to contact point is not necessarily the greatest mesiodistal diameter. However the difference is slight.

Observations and Results

I)C ompa ris ons of too th bet ween ri ght and left side s: si zes

No significant differences were present except in the mandibular central incisor, where right side incisor was larger than left side (P= 0.026) and mandibular first premolar, where left side premolar was larger than right side (P = 0.021). As a result, for each subject the size of the teeth on the right and left sides were averaged, and the averages were used for subsequent statistical calculations.

II) M al e an d Fe ma l e c om p a ri s on s :
Preliminary analysis indicated that predictive differences between the sexes were statistically not significant for both the prediction methods in maxilla as well as in mandible. So the prediction equations for Marathi population were not calculated separately for males and females.

Methodology
For particular sum of mandibular incisors, Moyers chart was used to find out percentage level at which the measured sum width of maxillary and mandibular canine and premolars falls. The values were also calculated by using Moyers probability chart at 75% level as suggested by Moyers, for given sum of mandibular incisors.
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Two Non-radiographic Techniques of Mixed Dentition Analysis and Evaluation .. Sushma Sonawane

III) Di ffer enc es bet ween th e a ctual an d p r ed i c te d t ooth si z e: The findings indicated that the differences between the predicted width of the canine and premolars by Tanaka Johnston and Moyers method and actual widths were highly significant in the statistical sense, as indicated by t tests. Tanaka Johnston approach slightly over estimated the tooth size of the unerupted canine and premolars(Mean = -0.95 + 1.18) in mandible and (Mean = -0.63 + 1.17) in maxilla. Moyers probability at 75% level also over estimated the tooth size of the unerupted canine and premolars in both mandible (Mean = -1.12 + 1.17), and maxilla (Mean = -0.71 + 1.17). This result illustrates that both the prediction methods overestimate the actual tooth size. IV) Co rrela tion c oeffici en t (r) between the p redict ed and actu al teeth s ize: There are statistically significant correlations between the actual and predicted tooth size obtained by both Tanaka Johnston approach and Moyers 75% confidence level, as r value forTanaka Johnston prediction arer= 0.551 for mandibular teeth r= 0.424 for maxillary teeth. Moyers 75% level arer= 0.559 for mandibular teeth. r= 0.435 for maxillary teeth. In general the r values are higher for the Moyers 75% prediction than for Tanaka Johnston prediction approach. r= 0.551 in mandible. r= 0.424 in maxilla. VI) Simpl e linea r r eg ression

VII ) P r ed i cti on of % p r ob ab i l i t y level t o b e used for Ma ra thi p op u l ati on : Table no.9 illustrates the descriptive analysis for the prediction of probable % level to be used for Marathi population. The mean values obtained are, 39.67% in mandible and 47.2% in maxilla. These values closely follow Moyers charts at 50% confidence level rather than the more commonly used 75% confidence level as suggested by Moyers. These results show that to get a more realistic estimate of width of canine and premolar for Marathi population, we should take the value at 50% level from the Moyers charts.

Summary and conclusion

The purpose of this study was to compare two non radiographic mixed dentition prediction methods, Tanaka Johnston and Moyers, and to evaluate their applicability to Marathi population. From this study following conclusions can be drawn1) Two non radiographic methods for predicting mesiodistal diameter of the unerupted maxillary and mandibular canine and premolars, Tanaka Johnston and Moyers, have comparable standard errors of estimate, therefore accuracy of both the prediction methods is fairly comparable and any one of these methods can be used according to convenience. 2) Both the prediction methods over estimated the actual tooth size of unerupted canine and premolars in Marathi population, therefore both prediction methods would not be as accurate in this population. 3) Moyers chart at 50% confidence level gives more realistic estimate of width of unerupted canine and premolars as compared to 75% confidence level for Marathi population. 4) To get more precise results in Marathi population, instead of using Tanaka Johnston prediction equations, the use of newly developed regression equations is suggested.

analysis: Following the guidelines for statistical analysis as described in the methodology, and by using data, regression equations were formulated, separately in maxilla and in mandible Y = a + b (X) w h e r e , X= independent variable (mandibular incisors measurements) Y = dependent variable (sum of canine and premolars). For mandibular teeth, Y = 10.830 + 0.563 (X) For maxillary teeth, Y = 12.143 + 0.481 (X)
Scientific Journal

Vol. II - 2008

Two Non-radiographic Techniques of Mixed Dentition Analysis and Evaluation .. Sushma Sonawane

References
1. Nance HN. The limitations of orthodontic treatment in mixed dentition diagnosis and treatment.AJO1947; 33:177-223. 2. Tanaka M M, Jonston L E. Prediction of size of unerrupted canines and premolars in contemporary orthodontic population.JADA:1974;88:798-80 3. Staley R N, Hoag. Prediction of mesiodistal width of maxillary permanent canine and premolars. AJO1978;73:169-177 4. Hunter WS, Priest WR. Errors and discrepancies in measurement of tooth size. JDR 1960;39:405414. 5. Moyers RE. handbook of orthodontics for the students and general practioner, Chicago year book, Medical publishers Inc 1973:369-379.

Scientific Journal

Vol. II - 2008