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Qiong Nie, DDS, MS, PhD,a and Jiuxiang Lin, DDS, MS, PhDb
Beijing, China
The purpose of this study was to determine whether there is a prevalent tendency for intermaxillary tooth
size discrepancies among different malocclusion groups. This study consisted of 60 subjects who served as
the normal occlusion group and 300 patients divided into 5 malocclusion groups (ie, Class I with bimaxillary
protrusion, Class II Division 1, Class II Division 2, Class III, and Class III surgery). Tooth size measurements
were performed on the models of normal occlusion and pretreatment models of patients by the Three
Dimension Measuring Machine. Moreover, tooth size ratios, analyzed as described by Bolton and the
Student t test showed no sexual dimorphism for these ratios in each of 6 groups, so the sexes were
combined for each group. Then these ratios were compared among different malocclusion groups. The
results showed no significant difference between subcategories of malocclusion, so these groups were
combined. There were now 120 cases in each of 3 categories: Class I, Class II, and Class III. A significant
difference was found for all the ratios between the groups, the ratios showing that Class III > Class I > Class
II. It demonstrated that intermaxillary tooth size discrepancy may be one of the important factors in the
cause of malocclusions, especially in Class II and Class III malocclusions. Thus this study proved the fact
that Bolton analysis should be taken into consideration during orthodontic diagnosis and therapy. (Am J
Orthod Dentofacial Orthop 1999;116:539-44)
ical University; Vice President, Beijing Medical University. Class I > Class II Division 1 > Class II Division 2 for
Reprint requests to: Dr Qiong Nie, Department of Orthodontics, School of mandibular teeth. It can be inferred that as a general
Stomatology, Beijing Medical University, No 38, BaiShiQiao Road, HaiDian trend, the Bolton discrepancy would be greater in
District, Beijing, 100081 China; e-mail, Liuyq@infoc3.icas.ac.cn
Copyright © 1999 by the American Association of Orthodontists. Class III cases than other malocclusion groups but
0889-5406/99/$8.00 + 0 8/1/100624 this was not analyzed for individuals.
539
540 Nie and Lin American Journal of Orthodontics and Dentofacial Orthopedics
November 1999
χ SE SD χ SE SD
Normal occlusion
RA 81.10 .60 2.27 81.95 .42 2.28
RP 104.24 .48 2.63 104.19 .59 3.23
RO 93.11 .48 2.64 93.44 .43 2.35
Bimaxillary protrusion
RA 81.25 .52 2.87 81.87 .46 2.51
RP 104.75 .66 3.61 104.61 .59 3.24
RO 93.41 .46 2.53 93.62 .44 2.42
Class II Division 1
RA 80.80 .44 2.42 80.31 .71 3.87
RP 102.74 .70 3.86 103.35 .61 3.34
RO 92.21 .44 2.39 92.11 .48 2.61
Class II Division 2
RA 80.97 .49 2.66 81.07 .64 3.52
RP 101.91 .60 3.28 102.41 .53 2.92
RO 91.82 .41 2.26 92.09 .49 2.70
Class III
RA 83.10 .61 3.33 82.60 .57 3.12
RP 107.14 .57 3.12 107.60 .90 4.92
RO 95.62 .44 2.43 95.49 .55 3.01
Class III surgery
RA 82.67 .46 2.51 82.61 .50 2.75
RP 107.31 .58 3.17 108.36 .63 3.47
RO 95.41 .45 2.44 95.86 .46 2.52
Malocclusion
RA 81.76 .24 2.90 81.69 .27 3.27
RP 104.77 .33 4.03 105.26 .35 4.29
RO 93.69 .23 2.86 93.83 .25 3.08
RA
Normal occlusion 81.52 2.82 1 1:Grp 1,2,3,4
Bimaxillary protrusion 81.56 2.69 2 2:Grp 1,2,5,6
Class II Division 1 80.56 3.21 3 Grp 3<4<1<2<6<5
Class II Division 2 81.02 3.10 4
Class III 82.85 3.20 5 * *
Class III surgery 82.64 2.61 6 * *
RP
Normal occlusion 104.21 2.92 1 1:Grp3,4
Bimaxillary protrusion 104.68 3.40 2 * 2:Grp 1,3
Class II Division 1 103.03 3.59 3 * 3:Grp1,2
Class II Division 2 102.16 3.09 4 * 4:Grp 5,6
Class III 107.37 4.09 5 * * * * Grp 4<3<1<2<5<6
Class III surgery 107.84 3.34 6 * * * *
RO
Normal occlusion 93.27 2.48 1 1:Grp 3,4
Bimaxillary protrusion 93.51 2.46 2 2:Grp 1,2
Class II Division 1 92.16 2.48 3 * * 3:Grp 5,6
Class II Division 2 91.95 2.47 4 * * Grp 4<3<1<2<5<6
Class III 95.55 2.71 5 * * * *
Class III surgery 95.63 2.47 6 * * * *
Table III. Comparison of tooth size ratios among the three occlusion categories
χ SD Group 1 2 3 Subset and order
RA
Class I 0.8154 0.0275 1 Grp 2<1<3
Class II 0.8079 0.0315 2 *
Class III 0.8275 0.0291 3 * *
RP
Class I 1.0445 0.0317 1 Grp 2<1<3
Class II 1.0260 0.0336 2 *
Class III 1.0760 0.0373 3 * *
RO
Class I 0.9339 0.0246 1 Grp 2<1<3
Class II 0.9206 0.0247 2 *
Class III 0.9559 0.0258 3 * *
Class III surgery, between normal occlusion and Class level of significance P < .05. For example, overall
I bimaxillary protrusion, between Class II Division 1 ratios of the 3 categories were 95.59 ± 2.58, 93.39 ±
and Class II Division 2. 2.46, 92.06 ± 2.47, respectively.
Because there is no significant difference between
subcategories of malocclusion, these groups are com- DISCUSSION
bined. There are now 120 cases for each category of When the whole malocclusion samples (ie, 150
Angle classification. Then the Multicomparison was female or 150 male patients) were combined into 1
performed between 3 new groups and the statistical group, our study shows that tooth size ratios of the
results were summarized in Table III. It shows that the malocclusion group are close to that of the normal
tendencies of anterior ratio, posterior ratio, and overall occlusion group, as shown in Table I. For example, the
ratio were all Class III > Class I > Class II, the differ- overall ratio of the normal occlusion group for female
ences between these groups were significant at the patients is 93.11 ± 2.64; for the malocclusion group it
American Journal of Orthodontics and Dentofacial Orthopedics Nie and Lin 543
Volume 116, Number 5
was 93.69 ± 2.86. Zhu Xia and Xiying Wu10 also converted to dental Class I malocclusions by forward
found no significant difference for tooth size ratios movement of permanent first molar due to the prema-
between the malocclusion group and the normal occlu- ture loss of the deciduous second molar, so the Class I
sion group after measuring mesiodistal tooth sizes of group may contain skeletal Class I and Class II
1173 Han nationality cases on their models. Thus, only patients. In the current study, skeletal categories were
after comparing tooth size ratios among different clas- taken into account, and in order to simplify this study,
sified malocclusion groups, can the law of nature be the cases were selected by the criteria of occlusal cate-
observed. gories coinciding with skeletal categories.
Sperry et al6 showed that the Class III group with Second, Crosby and Alexander7 did not differenti-
mandibular prognathism had more patients with ate between sexes and did not mention the ratio of
mandibular tooth-size excess for the overall ratio than sexes in each group. In their study, it was not clear
the Class I and Class II groups (0.01 < P < .05). This whether there was sexual dimorphism for tooth size
conclusion was similar to a result of the present study. ratios. The present study separated sexes and demon-
The similar result was that the overall ratio of Class III strated that there was no sexual dimorphism for tooth
surgery was the highest among different malocclusion size ratios, thus the sexes were combined in the ratio of
groups. However, the present study demonstrated that 1:1 for each group.
not only Class III surgery but also Class III nonsurgery Third, Crosby and Alexander7 did not include Class
had a greater frequency of mandibular tooth size excess III patients in their study and only selected 20 to 30
than other malocclusion groups. cases for each group. However, in the current study, not
Lavelle5 showed that tooth sizes of Class III were only Class III but also Class III surgery patients were
the smallest among the 3 occlusion categories (ie, Class included and 60 cases were contained in each of the 6
I, Class II and Class III) for maxillary teeth; they were groups. As mentioned previously, because there was no
the greatest for mandibular teeth. This possibly indi- significant difference between subcategories of maloc-
cated that tooth size ratios of mandibular teeth divided clusion, these groups could be combined. There were
by maxillary teeth in Class III may be the greatest 120 cases in each category of Angle classification in
among different malocclusion types. However, these the present study. Therefore, the samples of the current
ratios were not compared in his study. His result was study were greater and classification of malocclusion
only a kind of descriptive statistical result, which stated was more complete than their study.
the mean size of each tooth of male patients for each Finally, the samples of the Class I group in the
malocclusion type and described a pattern of contrast. Crosby and Alexander7 study were composed of Class
The present study compared these ratios and showed I malocclusion in which no prevalent clinical presenta-
that anterior ratio, posterior ratio, and overall ratio of tions were mentioned, but that of the present study
Class III malocclusions were all greater than other were made up of normal occlusion and Class I maloc-
occlusion categories. clusion with bimaxillary protrusion. This may be
Crosby and Alexander7 also compared the tooth another reason that led to the differences in results
size ratios among different malocclusion groups, as in between their study and ours.
the current study. They found that there were no sig- In clinical practice, clinicians often note the dis-
nificant differences among Class I, Class II Division 1, crepancy of tooth size and skeletal size but seldom pay
Class II Division 2, and Class II surgery groups. The attention to tooth size discrepancy between maxillary
current study also determined that no significant dif- and mandibular teeth. The present study showed the
ferences exist between Class II Division 1 and Class II tendency of mandibular tooth size excess in Angle
Division 2, but other results were different from their Class III malocclusion and the tendency of maxillary
study. The present study showed that the 3 tooth size tooth size excess in Angle Class II malocclusion. This
ratios were all Class III > Class I > Class II and the dif- indicated that it might be reasonable for orthodontists
ferences between these groups were significant. The to do interproximal stripping or tooth extraction in the
differences of results between the current study and mandibular dentition for Class III malocclusion and in
Crosby and Alexander 7 study could be explained as the maxillary dentition for Class II malocclusion.
follows. These results suggested that the Bolton analysis is
First of all, the skeletal categories were not men- important and should be considered when diagnosing,
tioned in Crosby and Alexander’s study although some planning, and predicting prognosis in clinical ortho-
of Class II cases were treated surgically. This may have dontics.
an important effect on the selection of sample. For In the current study, the Class I malocclusion group
example, some skeletal Class II malocclusions can be only consisted of bimaxillary protrusion because of the
544 Nie and Lin American Journal of Orthodontics and Dentofacial Orthopedics
November 1999
consideration of our other studies. This was a defect of 2. When tooth size ratios were compared, there were no sig-
sample selection. But it demonstrated that Class I cases nificant differences between normal occlusion and Class I
with bimaxillary protrusion had no prevalent incidence bimaxillary protrusion, between Class II Division 1 and
of intermaxillary tooth size discrepancy. The samples of Class II Division 2, between Class III and Class III
other clinical presentations are needed to be added into surgery patients.
the Class I group to further determine the relationship of 3. The tendencies of the 3 tooth-size ratios for the 3 occlu-
Class I to Class II or Class I to Class III. For Class II and sion categories were all Class III > Class I > Class II at the
Class III malocclusions, this study showed a prevalent level of significance P < .05. It suggests that the tooth size
tendency of intermaxillary tooth size discrepancy. discrepancy between maxillary and mandibular teeth may
Although tooth size and tooth size ratios described be one of the important factors in the cause of malocclu-
by Bolton were different in different racial groups, and sions, especially in Class II and Class III malocclusions.
the order was Negroids > Mongoloids > Caucasoids.8 In order to obtain optimal and stable treatment results, the
However, there are little data in relation to the degree Bolton analysis should be taken into consideration when
and frequency of intermaxillary tooth size discrepancy diagnosing, planning, and predicting prognosis in clinical
in different racial groups for the same malocclusion orthodontics.
category. This study demonstrated a statistical ten-
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