|Year : 2013 | Volume
| Issue : 4 | Page : 269-274
Applicability of tooth size predictions in the mixed dentition space analysis in Nalgonda population
M Manjula1, S Thabitha Rani2, Sushmitha Rachel David3, E Rajendra Reddy4, N Sreelakshmi5, A Rajesh6
1 Professor, Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh, India
2 Reader, Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh, India
3 Practitioner, Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh, India; Practitioner, Kuwait
4 Professor and HOD, Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh, India
5 Professor, Senior Lecturer, Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh, India
6 Senior Lecturer, Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda, Andhra Pradesh, India
|Date of Web Publication||26-Nov-2013|
H. No. 6-1-103/105, Padma Rao Nagar, Secunderabad - 500 025, Andhra Pradesh, India
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study was to evaluate the applicability of the Tanaka-Johnston and Moyer's methods for predicting the size of permanent canines and premolars in Nalgonda population.
Materials and Methods: 200 sets of dental casts (13-16 years) of the permanent dentition with no detected abnormalities were obtained from children attending in and around the schools of Nalgonda. The actual mesiodistal crown diameters were measured with digital vernier calipers (Zoom, Japan) to accuracy of 0.01 mm. The actual values were then compared with the predicted values derived from the Tanaka and Johnston equations and Moyer's probability tables. Correlation and linear regression analyses were performed between the predicted and the actual tooth size and standard regression equations were developed.
Results: In the present study, Tanaka and Johnston regression equation overestimated the mesiodistal widths of permanent canine and premolars (P < 0.001). At all probability levels in Moyers prediction table, there was no statistical difference between the actual and predicted mesiodistal widths of maxillary and mandibular canines and premolars.
Conclusion: Tanaka and Johnston analysis overestimated the actual widths of the unerupted canines and premolars in the maxillary and mandibular arches of male and female subjects of Nalgonda population. New standardized regression equations were formulated for the prediction of the mesiodistal widths of unerupted canines and premolars. Moyer's prediction tables can be used at all probability levels for male and female subjects of Nalgonda.
Keywords: Digital vernier calipers, Moyers mixed dentition analysis, Tanaka and Johnston analysis
|How to cite this article:|
Manjula M, Rani S T, David SR, Reddy E R, Sreelakshmi N, Rajesh A. Applicability of tooth size predictions in the mixed dentition space analysis in Nalgonda population. J NTR Univ Health Sci 2013;2:269-74
|How to cite this URL:|
Manjula M, Rani S T, David SR, Reddy E R, Sreelakshmi N, Rajesh A. Applicability of tooth size predictions in the mixed dentition space analysis in Nalgonda population. J NTR Univ Health Sci [serial online] 2013 [cited 2020 Apr 4];2:269-74. Available from: http://www.jdrntruhs.org/text.asp?2013/2/4/269/122165
| Introduction|| |
Dental arch dimension is of primary concern to a pediatric dentist who occupies a pivotal position in providing a smooth transition from the primary, through the mixed to the permanent dentition.
Early diagnosis and successful treatment of developing malocclusions can have both short-term and long-term benefits while achieving the goal of occlusal harmony, function and dental facial esthetics. Mixed dentition space analysis (MDSA) plays an important role in the diagnosis of tooth size arch length discrepancies. 
In order to analyze a case comprehensively predictive methods should be accurate, safe, simple, rapid (fast to carry out) not require any special equipment and be useful for both dental arches. The dental literatures is replete with numerous prediction methods viz. using probability tables ,, monographs,  radiographs , proportional fractions, , regression equations  etc. for determining an accurate occlusal guidance and treatment plan. Among these, the Moyer's and Tanaka and Johnston's methods are most widely used, although other methods using radiographs are suggested to be more accurate.
The existence of a good correlation between the size of the permanent lower incisors and sizes of permanent canines and premolars was first proved by Carey.  Ballard and Wylie,  first established the regression equations.
Moyer's  suggested MDSA using probability tables to predict the sizes of unerupted permanent canines and premolars from the sum of the widths of the lower permanent incisors. Despite a tendency to overestimate the size of unerupted permanent teeth, the accuracy was fairly good for North European white children on which the data is based. However, the accuracy is still questionable when applied to other population groups according to Proffit and Fields  and it has been reported that significant differences in tooth sizes exist among different ethnic population. ,, Based on the reported secular increase in dimensions of teeth by Lavelle  in 1972, Tanaka and Jhonston  in 1974 reassessed Moyers analysis and established a simple approximation equations to predict the widths of an unerupted permanent canines and premolars for both jaws and genders by using the sum of mesiodistal widths of lower permanent incisors.
The purpose of this study was to evaluate the reliability, applicability of Moyer's probability tables and Tanaka and Johnston's regression equations for the prediction of unerupted permanent canines and premolars of both dental arches in Nalgonda population and to derive new regression equations if required, for this specific population.
| Materials and Methods|| |
The study was approved by Ethics and Research Committee. The sample for the study consisted of 200 school children aged 13-16 years with both genders equally distributed (Male = 100, Female = 100), attending different schools in Nalgonda. An informed written consent was obtained from the parents of all subjects who underwent clinical examination and impressions. The criteria for selection of the sample were as follows: presence of acceptable occlusion with Cl I molar and canine relation, fully erupted permanent dentition and free of approximal cavities, restorations, fractures, congenital defects, tooth wear or impactions. Many authors have adopted these criteria. ,,
Alginate impressions of maxillary and mandibular arches were made and poured in dental stone. The mesiodistal dimensions of mandibular permanent central and lateral incisors, maxillary and mandibular permanent canines, first and second premolars were measured by digital vernier calipers (Zoom, Japan) with accuracy of 0.01 mm [Figure 1]. The tips of the calipers were precision engineered to facilitate the greatest degree of accuracy. The mesiodistal dimension of teeth was obtained by measuring the maximum distance between approximate surfaces of the teeth as described by Hunter and Priest.  Teeth were measured manually and independently by two investigators as suggested by Bishara. , The two measurements obtained by the investigators were compared and if they varied by 0.2 mm or less, the values were averaged.
|Figure 1: Tooth measurement procedure using vernier digital caliper (Zoom, Japan)|
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Descriptive statistics, including means, standard deviations and minimum and maximum values were calculated for the actual tooth size and the predicted tooth size using the Moyers and the Tanaka and Johnston methods. Student's paired t-tests were carried out to determine whether a significant difference existed between the regression values using Moyer's tables and the Tanaka and Johnston equation with the actual canine and premolars width measurements. Correlation and linear regression analyses were performed between the predicted and actual teeth size for the Tanaka and Johnston's prediction method. The constants "a" and "b" in the standard regression equation(Y = a + b [X]) and the standard errors of the estimates were calculated.
| Results|| |
The difference (in mm) between the regression values of actual sum of permanent canines and first and second premolars and those predicted from Tanaka and Johnston equations are shown [Table 1]. Tanaka and Johnston analysis over-estimated the mesiodistal widths of permanent canines and premolars in maxillary and mandibular arches for both male and female subjects and the difference between the regression values was found to be statistically significant (P < 0.0001).
|Table 1: The Difference (In Mm) Between the Regression Values of Actual Sum of Permanent Canines and First and Second Premolars and Those Predicted from Tanaka and Johnston Equations for the Same Subjects|
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[Table 2] and [Table 3] shows the differences between the actual canine and premolar widths and the predicted widths of the canine and premolar for upper and lower arches derived from Moyers charts at different probability levels. There were no statistically significant differences between actual mesiodistal widths of canines and premolars and the predicted widths from Moyer's charts at all probability levels for lower and upper arches in male and female subjects.
|Table 2: The Difference (in MM) Between the Mean Actual Sum of the Lower Canine and Premolars and Those Predicted from Moyers Charts for all Subjects|
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|Table 3: The Difference (In MM) Between the Mean Actual Sum of The Upper Canine and Premolars and Those Predicted from Moyers Charts for the Same Subjects|
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[Table 4] shows the coefficient correlations r between the mandibular incisors and sum of upper canines and premolars and the sum of the lower canine and premolars, regression values a and b the standard error of estimate and the 95% of confidence interval for the sexes combined and also for the female and male subjects separately.
|Table 4: Regression Parameters for Prediction of Sum of Unerupted Upper and Lower Permanent Canine and Premolars Widths for Indian Male and Female Subjects|
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The correlation coefficients between the sum of the mandibular incisors and the sum of canines and premolars were 0.40 (for lower) and 0.25 (for upper) in female subjects and 0.59 and 0.46 respectively, in male subjects. When both sexes were combined, the coefficients were 0.50 for the lower and 0.36 for the upper arches respectively. Standard error of estimate ranged from 0.60 to 0.90. Nearly95% of confidence interval values ranged from 13.16 to 20.90. The values of coefficient "b" ranged from 0.12 to 0.33 and were all significant at P < 0.001.
| Discussion|| |
As early treatment is becoming increasingly critical in pediatric dentistry and orthodontics, MDSA is an essential diagnostic procedure for an accurate diagnosis and treatment planning. The trend toward earlier treatment reflects better comprehension of malocclusion and their diagnosis. 
Moyer's recommended using the 75 th percentile level of probability in his tables to protect on the crowded side.  Data collected from one ethnic group for the purpose of predicting the size of unerupted permanent teeth might not be applicable to another. 
The Tanaka and Johnston method of space analysis is mostly considered as it requires no radiographs or tables to predict the size of unerupted teeth. 
In the present study, Tanaka and Johnston analysis significantly overestimated the actual mesiodistal widths of maxillary and mandibular canines and premolars in both male and female population of Nalgonda. The results of this study were strongly comparable with the findings of the investigations done in India by Anil Chandna et al.,  Sonawane et al.  Similarly, several studies which were carried out in various populations around the world showed that Tanaka and Johnston analysis overestimated the actual mesiodistal widths of canines and premolars in their respective subjects. ,,,,,,,,,,
Data from this study were used to generate statistically significant regression equations that can be used in prediction of unerupted canines and premolar widths for Nalgonda children. New Regression equations in the form of Y = a + b (X) were formulated.
In the maxilla:
- For male subjects: Y = 11.0 + 0.500(X)
- For female subjects: Y = 11.1 + 0.495(X)
In the mandible:
- For male subjects: Y = 10.4 + 0.506(X)
- For female subjects: Y = 10.4 + 0.502(X)
X = the measured width of the four permanent mandibular incisors in millimeters.
Y = the predicted size of the canine and premolars in one quadrant in millimeters.
From the results obtained in the present study, it was found that Moyer's mixed dentition analysis of prediction can be used at all probability (5%, 15%, 25%, 35%, 50%, 65%, 75%, 85% and 95%) levels in both male and female subjects of Nalgonda. The present findings were consistent with the results of studies reported by Anil Chandna et al. (2011)  and Abu Alhaija and Qudeimat (2006).  Sable et al.  recommended the use of the 65% level of probability rather than 75% levels as suggested by Moyers for the particular width of the lower incisors. Rani and Goel et al.  found that 35% level of probability was more accurate than 75% level as suggested by Moyers. Sonawane et al. (2008)  found that 50% level of probability was more accurate than 75% level as suggested by Moyer's in Marathi population. Durgekar et al. (2009)  concluded that Moyers prediction tables were not accurate when applied to their sample and the differences noted between predicted values of the Moyer's tables and those of the investigation are the result of racial and ethnic diversity.
| Conclusions|| |
Tanaka and Johnston analysis significantly overestimated the actual widths of the unerupted canines and premolars in maxillary and the mandibular arches of male and female subjects of Nalgonda population. Regression equations were formulated for prediction of the widths of unerupted canines and premolars in Nalgonda children. Moyer's prediction tables can be used for mixed dentition analysis at all probability levels for male and female subjects of Nalgonda.
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[Table 1], [Table 2], [Table 3], [Table 4]