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Original Article

Evaluation of Moyer’s mixed dentition space

analysis in Indian children
Kamalshikha Baheti, Prashant Babaji1, Meer J. Ali, Ashish Surana, Samvit
Mishra2, Madhulika Srivastava3
Department of Orthodontics, College of Dental Sciences and Hospital, Rau, Indore, 2Department of Orthodontics, Bhabha College of
Dental Sciences, Bhopal, Madhya Pradesh, 1Department of Pedodontics and Preventive Dentistry, Sharavthi Dental College, Shimoga,
Karnataka, 3Department of Pedodontics, Babu Banarasi Das College of Dental Sciences, Lucknow, Uttar Pradesh, India
Corresponding author (email: <babajipedo@gmail.com>)
Dr. Prashant Babaji, Department of Pedodontics and Preventive Dentistry, Sharavthi Dental College, Shimoga, Karnataka,
India.

Received: 28-03-16 Accepted: 26-04-16 Published: 24-10-16

Abstract
Aim and Objectives: Tooth size prediction values are not universal for all ethnic and racial groups. The present study
evaluated the applicability of Moyer’s mixed dentition space analysis in the Marwari community of Rajasthan, India.
Materials and Methods: The mesiodistal dimension of permanent mandibular incisors, maxillary and mandibular
canine, and premolars of both sides were measured and averaged in 200 adolescents (100 males and 100 females) of the
Marwari population in Rajasthan using digital Vernier caliper. Data were statistically analyzed using Student’s t–test.
The data were then compared with Moyer’s predicted values. The tooth measurements of male and female participants
were compared with unpaired t-test. Results: Moyer’s prediction chart was not comparable with the study population
group. The coefficient of correlation and coefficient of determination in our study was 0.57 and 0.25, respectively.
Mesiodistal width of measured teeth was lesser in females compared to males for both canine and premolars ( P = 0.471
and P = 0.0001, respectively). Conclusion: There was significant statistical difference between values of the present
study and Moyer’s prediction values. Hence, new regression equation and prediction table can be used to predict
mesiodistal dimensions of canine and premolars in Marwari children of Rajasthan.

Key words: Mixed dentition, Moyer’s analysis, prediction table, space analysis

INTRODUCTION for establishing treatment plans and management

In most of the cases, malocclusion starts during mixed
dentition stage. Earlier diagnosis and management of
developing malocclusion helps to resolve the problem
effectively. Unerupted maxillary and mandibular canine
and premolars can be assessed with the mesiodistal width
of the erupted permanent mandibular incisors. Prediction
of the unerupted teeth size in mixed dentition stage is a
key factor
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of developing malocclusion.[1-4] Mixed dentition
space analysis (MDSA) helps in identifying the space
discrepancy. MDSA also helps in determining treatment
plan and assessing tooth eruption, space maintenance,
space regaining, serial extraction, or for periodic
evaluation.[5,6]
MDSA to predict the width of unerupted permanent
canines and premolars can be based on four basic
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DOI: How to cite this article: Baheti K, Babaji P, Ali MJ, Surana A, Mishra S,
10.4103/2231-0762.184037 Srivastava M. Evaluation of Moyer's mixed dentition space analysis in
Indian children. J Int Soc Prevent Communit Dent 2016;6:453-8.

453 © 2016 Journal of International Society of Preventive and Community Dentistry | Published by Wolters Kluwer - Medknow
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Baheti, et al.: Evaluation of Moyer’s mixed dentition space analysis in Indian children
principles, i.e., the measurement of unerupted teeth on
periapical radiographs, from prediction tables and
equation, a combination of prediction tables and
radiographs, and regression equation methods.[5,7] Various
MDSA have been advised such as Moyer’s, Tanaka–
Johnston’s, and radiographic methods. All these methods
have one or the other drawbacks. However, regression
equation method seems to be relatively accurate.[2,5,8-10]
Moyer’s analysis is the most widely used method. This
MDSA is used to assess the mesiodistal width of
unerupted canine and premolars using probability chart at
the 75th percentile.[1] However, this prediction was based
on North American Caucasian children. It is not
applicable to all racial groups because it has been
observed that tooth dimension varies in different
ethnicities, races, and genders.[1,3,5,11]
Various studies have shown that Moyer’s prediction table
is not applicable to all the races, and they have developed
different prediction tables.[1,3,4,11] Agarwal et al.,[1]
Thimmegowda et al.,[3] Singh et al.,[12] and Durgekar and
Naik[11] found different tooth size measurements, and
created prediction tables for Indian children of different
locations; similarly, new regression equations were
developed for tooth size prediction by Hammad and
Abdellatif[4] for Egyptian children, Al-Bitar et al.[6] for
Jordanian population, and Toodehzaeim et al.[7] for
Iranian population.
If the predicted values of unerupted canine and premolar
are wrong, then the whole treatment may be a failure. [12]
Hence, the present study was undertaken to evaluate
tooth width in males and females and to assess the
applicability of Moyers probability tables in the Marwari
children of Rajasthan as well as to formulate a more
appropriate mixed dentition prediction chart.
MATERIALS AND METHODS
The Marwari community in Rajasthan has a rich
cultural heritage, with limited racial mixing due to
strong family bonds. School children belonging to
the Marwari community and residing in Jodhpur city
were included for this study. Children’s domicile and
community were confirmed from school records, by
questionnaire, and certificate issued from the Tashildar
office. A total of 200 school children (200 males
and 100 females) of age group 13–16 years were
randomly selected from the Marwari community
from 6 schools in Jodhpur city who met the selection
criteria. 173 samples were selected from 1492 total
September-October 2016, Vol. 6, No. 5
strength at 95th confidence level with a confidence
interval of 7; the sample size was then adjusted to 200.
The nature of the study was clarified to the participants
and parents, and written informed consent was obtained
from the school authority and parents of the participating
children. The study was carried out from July 2014 to
October 2014.
Alginate impression of the upper and lower arch of all
participating children was made and poured immediately
in dental stone (Type III) to prevent dimensional
changes. A digital Vernier caliper with a resolution of
0.01 mm was used to measure the mesiodistal width of
the individual teeth (mandibular permanent incisors and
canine and premolars of maxillary and mandibular arch)
[Figure 1]. Mean values of the misiodistal width of the
lower incisors (LI), upper canine and premolars (UCPM),
and lower canine and premolars (LCPM) were recorded.
Values of the left and right side were averaged to obtain a
single mean value. The measurements were made
between two contact points of each tooth, parallel to the
occlusal and vestibular surfaces, as described by Jensen
et al.[13] The teeth on the model cast were measured
manually by a single trained researcher. The reliability of
coefficient of the test was confirmed from the pilot
sample study. To facilitate accuracy in measurement,
participants with an arch length discrepancy of ±2 mm
were included. To check the reliability of measurements,
two obtained measurements were compared, and if they
varied by 0.2 mm or less, the values were averaged. If
values varied by 0.2 mm, teeth were again measured and
the nearest of the three measurements were averaged.
Inclusion criteria
• All fully erupted permanent teeth except third
molars should be present in both the arches
Figure 1: Digital Vernier caliper for tooth size measurement
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Baheti, et al.: Evaluation of Moyer’s mixed dentition space analysis in Indian children

• Both the patient and their parent should be a
domicile of Jodhpur, Rajasthan, for a minimum of 20 years and
the parents of the participants should belong to the Marwari
community
• Subjects should be in the age range of 13–16 years.
Exclusion criteria
• Tooth loss mesiodistally as a result of
interproximal caries, interproximal attrition, fracture, or
congenital defects
• Participants who have undergone orthodontic
treatment
• Any congenital craniofacial anomalies
All the measurements were recorded in an Excel
spreadsheet and subjected to statistical analysis.
Student’s t-test and standard linear regression was
evaluated using the Statistical Package for the Social
Sciences software version 18.0, (Chicago: SPSS Inc.,
2009) Student’s t-test was used to compare Moyer’s
prediction chart with the present values. The tooth width
of all subjects were compared with unpaired t-test. The
standard linear regression equation of the form Y = a +
b(X) was used to prepare new probability tables, [11,14]
where X is the combined mesiodistal width of the
mandibular permanent incisor, Y is the mesiodistal width
of the canine and premolar segments, a is the Y-intercept,
and b is the slope of the regression line.
RESULTS
In our samples, Moyer’s probability chart was not an
accurate method to predict tooth dimension. Table 1
indicates the mean and standard deviation values for
selected teeth. Table 2 indicates a difference in predictive
values. In our study, Moyer’s prediction table at the 75th
percentile overestimates the dimension whereas at the
50th and 35th percentile it underestimates the actual values
in both the genders [Table 2].
Table 3 indicates the coefficient of correlation (r),
regression constants (a, b), and coefficient of
determination (r2) for various tooth groups in different
groups of participants. The r and r2 in our study was 0.57
and 0.25, respectively [Table 3]. Mesiodistal width of
measured teeth was more in males compared to females
for both canine and premolars (P = 0.471 and P = 0.0001,
respectively) [Table 4]. Tables 5-8 are the prediction
tables of Moyer’s at 75th, 50th, and 35th percentile along
with the present 75th percentile prediction for the
Marwari community for both genders.
From our study, we have developed the following new
regression equations for the Marwari community of
Rajasthan to predict tooth width of unerupted teeth
Male: Maxilla- Y = 10.52 + 0.46x,
Mandible- Y = 9.45 + 0.48x
Female: Maxilla- Y = 11.67 + 0.45x,
Mandible- Y = 11.58 + 0.32x
DISCUSSION
MDSA is used to estimate the width of unerupted
permanent teeth for the diagnosis of developing
malocclusion.[2] Improper space analysis could lead to a
negative decision for extraction, which can affect the
patient’s facial profile.[11,12] Globally, Moyer’s mixed
dentition prediction table at the 75 th percentile with sum
of mesiodistal dimension of the erupted lower permanent
incisors is used to calculate the width of unerupted
permanent teeth.[11] Use of mandibular permanent incisor
for prediction is advantageous because it erupts early in
mixed dentition, is easy to measure, and has minor size
variations. Use of digital caliper with a standard error of
±0.03 mm has shown to be a more accurate to measure
tooth dimension. Maxillary incisors were not used in any
predictive procedure because they have variable size and
lower predictive values.[11,12]

Table 1: Mean and stander deviation for various

tooth groups Moyer’s prediction was not applicable in all races
Teeth Gender Total Mean (mm) SD (mm)because it was based on the North American population,
Group number and tooth dimensions and craniofacial characteristics
LI Male 100 22.10 1.886 differ among populations of various ethnicities, racial
UCPM Male 100 21.42 1.342 origins, genetics and genders.[1,5,11,12] This is in agreement
LCPM Male 100 20.86 1.512
with several researchers who have provided different
LI Female 100 21.98 1.824
regression analysis for prediction.[2,5,11] Revision in
UCPM Female 100 20.84 1.248
LCPM Female 100 20.25 1.478
racial- and gender-based space analysis is required once
SD= Standard deviation, LI=Lower incisor width, LCPM=Lower in every generation because of the changing trends in
Canine Premolar width, UCPM=Upper Canine Premolar width malocclusion and tooth size.[11]

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Baheti, et al.: Evaluation of Moyer’s mixed dentition space analysis in Indian children

Table 2: Comparison of actual and predictive values using student ‘t’ test
Gender Arch 75th percentile 50th percentile 35th percentile
‘t’ P ‘t’ P ‘t’ P
Male Maxillary 2.7893 0.0100 4.8767 0.0001 6.1657 0.0001
Male Mandibular 2.9856 0.0070 4.3451 0.0003 5.0125 0.0001
Female Maxillary 4.1854 0.0003 6.4566 0.0001 7.1234 0.0001
Female Mandibular 5.8956 0.0001 7.7889 0.0001 8.6567 0.00001

Table 3: Coefficient of correlation (r), Regression table at the 75th percentile overestimates the dimension,
constants (a,b), Coefficient of determination (r2) whereas at the 50th and 35th percentile, it underestimates
for various tooth groups in different groups of the actual values in both the genders [Table 2]. This is in
subjects accordance to studies conducted by various researchers.
Teeth groups Gender r a b r2 [1,10-12,15] This indicates racial and ethnical variations in
UCPM Male 0.3867 17.657 0.197 0.1355tooth width for canine and premolars.
LCPM Male 0.4355 13.770 0.267 0.2456
UCPM Female 0.3899 17.446 0.132 0.1247Table 3 presents the r, a and b, and r2 for various tooth
LCPM Female 0.5778 12.789 0.356 0.2578groups in different groups of subjects. The r and r2 in our
study was 0.57 and 0.25, respectively [Table 3]. These
LCPM=Lower Canine Premolar width, UCPM=Upper Canine Premolar width
values are in agreement with the values reported in the
Tables 4: Comparison of mesiodistal width of study by Agarwal et al.,[1] and are higher than those
group of teeth between male and females reported in the studies by Jaroontham and Godfrey [15]
(0.29 and 0.34), Durgekar and Naik[11] (0.56 and 0.25 r2),
Teeth groups Gender Mean SD SE P
LI Male 22.10 ±1.894 0.572 0.0138+
and Hammad and Abdellatif[4]
Female 21.87 ±1.842 (0.78 and 0.89 in male and 0.63 and 0.87 in female,
UCPM Male 21.36 ±1.342 0.179 0.0471+ respectively).
Female 20.94 ±1.254
LCPM Male 20.99 ±1.485 0.256 0.0001++Mesiodistal width of the measured teeth was lesser in
Female 20.15 ±1.458 females compared to males for both canine and
premolars (P = 0.471 and P = 0.0001, respectively)
Unpaired ‘t’ test. SD=Slandered deviation, SE=Slandered error, LI=
Lower incisor width, UCPM=Upper canine Premolar width, [Table 4]. This is in accordance to the studies conducted
LCPM=Lower Canine Premolar width, +=Significance, ++=Highly
significance by Agarwal et al. and Durgekar and Naik.[1,11,15] The
degree of accuracy (SE) for new equation ranges from
0.179 to 0.572 mm [Table 4]. This is in near range
Table 5: Prediction table for maxillary arch in
compared to study by Agarwal et al. (0.186–0.544 mm),
males with Moyer’s probability chart
and lower to results from Chandan et al. study (0.63–0.83
L* 75th 50th 35th Presentmm).[1,16]
percentile percentile percentile 75th
19.5 20.3 19.7 19.3 19.84 Our results indicate that Moyer’s prediction chart is not
20.0 20.5 19.9 19.6 20.14
accurate for the present study group. Hence, new
20.5 20.8 20.2 19.9 20.52
regression equations and prediction table has been
21.0 21.0 20.4 20.1 20.62
formulated for the Marwari community. The differences
21.5 21.3 20.7 20.4 20.86
22.0 21.5 20.9 20.6 21.02 noted in Moyer’s prediction chart with that of our study
22.5 21.8 21.2 20.9 21.35 are because of the changes in the racial and ethnic
23.0 22.0 21.5 21.1 21.61 diversity [Tables 5-8]. Tooth dimension is associated
23.5 22.3 21.7 21.4 21.82 with gender. Mesiodistal crown dimension in the buccal
24.0 22.5 22.0 21.6 22.15 segment of the mandibular arch is lesser in females
24.5 22.8 22.2 21.9 22.34 compared to males.
25.0 23.0 22.5 22.1 22.61
25.5 23.3 22.7 22.4 22.78 Multiple regressions equation method using mandibular
L*=Sum of mandibular incisors permanent incisors as a predictor value is
nonradiographic, easy to assess, practical, and precise
Table 1 presents the mean and standard deviation values method for assessing the mesiodistal dimension of
for selected teeth. Table 2 presents the difference in unerupted canine and premolars.[1] Different studies
predictive values. In our study, Moyer’s prediction
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Baheti, et al.: Evaluation of Moyer’s mixed dentition space analysis in Indian children

Table 6: Prediction chart for mandibular arch in have shown the variations in prediction and regression
males with Moyer’s probability chart equation to evaluate unerupted teeth.[1,3,4,11,12]
L* 75th 50th 35th Present
A limitation of the study was smaller group selection.
percentile percentile percentile 75th
19.5 20.4 19.5 19.0 19.31
This method can be applied in the study population with
20.0 20.6 19.7 19.3 19.42 the new regression formula and prediction table. Further
20.5 20.8 20.0 19.5 19.68 research is required to evaluate more appropriate
21.0 21.0 20.2 19.7 19.86 prediction charts on larger and different racial groups.
21.5 21.2 20.4 20.0 20.18
22.0 21.4 20.6 20.2 20.45
22.5 21.6 20.9 20.4 20.72 CONCLUSION
23.0 21.9 21.1 20.6 20.92
23.5 22.1 21.3 20.9 21.15 Moyer’s mixed dentition prediction table is not universal
24.0 22.3 21.5 21.1 21.46 for all racial groups; hence, individual regression analysis
24.5 22.5 21.7 21.3 21.83 and prediction table is more useful.
25.0 22.8 22.0 21.5 21.97
25.5 23.0 22.2 21.7 22.18 Financial support and sponsorship
L*=Sum of mandibular incisors
Nil.
Table 7: Prediction table for maxillary arch in
females with Moyer’s probability chart Conflicts of interest
L* 75th 50th 35th Present
percentile percentile percentile 75th There are no conflicts of interest.
19.5 20.4 19.6 19.2 19.75
20.0 20.5 19.8 19.4 19.92 REFERENCES
20.5 20.6 19.9 19.5 20.21
1. Agarwal N, Shashikiran ND, Singla S, Kulkarni VK, Ravi KS.
21.0 20.8 20.1 19.7 20.46
Moyer’s mixed dentition predictable values correlation among Hindu
21.5 20.9 20.2 19.8 20.59 children of Bhopal city. Ann Essence Dent 2013;5:6-10.
22.0 21.0 20.3 19.9 20.81 2. Juneja S, Mahajan N, Kaur H, Verma KG, Sukhija M, Bhambri E.
22.5 21.2 20.5 20.1 20.97 Comparative evaluation of three mixed dentition analyses and
23.0 21.3 20.6 20.2 21.15 formulation of regression equations for North Indian population:
A cross-sectional study. Biomed J 2015;38:450-5.
23.5 21.5 20.8 20.4 21.34
3. Thimmegowda U, Sarvesh SG, Shashikumar HC, Kanchiswamy LN,
24.0 21.6 20.9 20.5 21.54 Shivananda DH, Prabhakar AC. Validity of Moyer’s mixed dentition
24.5 21.8 21.0 20.6 21.74 analysis and a new proposed regression equation as a predictor of width of
25.0 21.9 21.2 20.8 21.95 unerupted canine and premolars in children. J Clin Diagn Res
25.5 22.1 21.3 20.9 22.21 2015;9:ZC01-6.
L*=Sum of mandibular incisors 4. Hammad SM, Abdellatif AM. Mixed dentition space analysis in
Egyptian children. Pediatric Dental J 2010;20:115-21.
5. Tikku T, Khanna R, Sachan K, Agarwal A, Srivastava K, Yadav P. A
Table 8: Prediction chart for mandibular arch in new proposed regression equation for mixed dentition analysis using the
females with Moyer’s probability chart sum of permanent mandibular four incisors and first molar as a predictor of
width of unerupted canine and premolars in a sample of North Indian
L* 75th 50th 35th Presentpopulation. J Orthod Sci 2013;2:124-9.
percentile percentile percentile 75th 6. Al-Bitar ZB, Al-Omari IK, Sonbol HN, Al-Ahmad HT, Hamdan
19.5 19.6 18.7 18.2 19.17 AM. Mixed dentition analysis in Jordanian population. Angle Orthod
20.0 19.8 19.0 18.5 19.38 2008;78:670-5.
20.5 20.1 19.2 18.8 19.61 7. Toodehzaeim MH, Aghili H, Shariatifar E, Dehghani M. New
regression equations for mixed dentition space analysis in an Iranian
21.0 20.3 19.5 19.0 19.82 population. J Contemp Dent Pract 2013;14:1156-60.
21.5 20.6 19.8 19.3 20.15 8. Oyeyemi VO, Oluranti CO. Mixed dentition analysis among Nigerian
22.0 20.8 20.0 19.6 20.28 population. IJCD 2013;4:31-6.
22.5 21.1 20.3 19.8 20.41 9. Mahmoud BK, Abu Asab SH, Taib H. Accuracy of four tooth size
23.0 21.3 20.5 20.1 20.68 prediction methods on Malay population. ISRN Dent 2012;2012:523703.
10. Ramesh N, Reddy MS, Palukunnu B, Shetty B, Puthalath U. Mixed
23.5 21.6 20.8 20.3 20.91 dentition space analysis in Kodava population: A comparison of two
24.0 21.9 21.1 20.6 21.06 methods. J Clin Diagn Res 2014;8:ZC01-6.
24.5 22.1 21.3 20.9 21.31 11. Durgekar SG, Naik V. Evaluation of Moyers mixed dentition analysis
25.0 22.4 21.6 21.1 21.46 in school children. Indian J Dent Res 2009;20:26-30.
25.5 22.7 21.8 21.4 21.71 12. Singh V, Singla A, Mahajan V, Jaj HS, Bawa T. Development of a
prediction equation for the mixed dentition in Himachal population. Indian
L*=Sum of mandibular incisors
J Dent Sci 2013;5:40-3.

457 Journal of International Society of Preventive and Community Dentistry September-October 2016, Vol. 6, No. 5
[Downloaded free from http://www.jispcd.org on Sunday, December 10, 2017, IP: 88.224.195.244]

Baheti, et al.: Evaluation of Moyer’s mixed dentition space analysis in Indian children

13. Jensen E, Kai-Jen Yen P, Moorrees CF, Thomsen TO. Mesiodistal
crown diameters of the deciduous and permanent teeth in individuals. J Dent Res
1957;36:39-47.
14. Philip NI, Prabhakar M, Arora D, Chopra S. Applicability of the
Moyers mixed dentition probability tables and new prediction aids for a
contemporary population in India. Am J Orthod Dentofacial Orthop
2010;138:339-45.
15. Jaroontham J, Godfrey K. Mixed dentition space analysis in Thai
population. Eur J Orthod 2000;22:127-34.
16. Chandna A, Gupta A, Pradhan KL, Gupta R. Prediction of the size of
unerupted canines and premolars in a North Indian population — An in
vitro study. J Indian Dent Assoc 2011;5:329-33.

September-October 2016, Vol. 6, No. 5 Journal of International Society of Preventive and Community Dentistry 458
 Moyer’s method of mixed dentition analysis: a meta-analysis
William Buwembo, Sam Luboga

Makerere University, Faculty of Medicine, Department of Anatomy, P.O. BOX 7072, Kampala

ABSTRACT
Background: Mixed dentition analysis forms an essential part of an orthodontic assessment. Moyer’s method which is
commonly used for this analysis is based on data derived from a Caucasian population. The applicability of tables
derived from the data Moyer used to other ethnic groups has been doubted. However no meta-analyses have been done
to statistically prove this.
Objective: To assess the applicability of Moyer’s method in different ethnic groups.
Study design: A meta-analysis of studies done on other populations using Moyer’s method.
Method: The seven articles included in this study were identified by a literature search of Medline (1966-June 2003)
using predetermined key words, inclusion and exclusion criteria. 195 articles were reviewed and meta-analyzed.
Results: Overall the correlation coefficients were found to be borderline in variation with a p-value of 0.05. Separation
of the articles into Caucasian and Asian groups also gave borderline p-values of 0.05.
Conclusion
Variation in the correlation coefficients of different populations using Moyer’s method may fall either side. This
implies that Moyer’s method of prediction may have population variations. For one to be sure of the accuracy while
using Moyer’s method it may be safer to develop prediction tables for specific populations. Thus Moyer’s method
cannot universally be applied without question.
Key words: meta-analysis, mixed dentition analysis, Moyer’s
method African Healthe Sciences 2004; 4(1) 45 -

INTRODUCTION in the mandibular or the maxillary arch) for

An orthodontic assessment has to be performed
before treating an orthodontic patient. In the
mixed dentition (temporally and permanent
dentition) patients, spacing or crowding of the
developing dentition is of prime concern 1. The
accumulated sizes of each child’s teeth may not
be in perfect relationship to the amount of space
in the child’s dental arches to accommodate the
dentition. When the accumulated sizes of the
teeth and the perimeter of the arch are not
closely correlated a spaced or a crowded
dentition results.
The assessment of spacing or crowding of
teeth is frequently associated with measurements
in the mixed dentition stage because accurate and
specific prediction of future dental developmental
events can be made at that stage 1. Mixed dentition
analysis thus forms an essential part of an
orthodontic assessment 1-4. This is because it helps
to determine the amount of space available
(whether
Correspondenceauthor
William Buwembo
Makerere University
Faculty of Medicine
Department of Anatomy
TelL 077 414863
E-mail: wbuwembo@yahoo.com
accommodation of the incremental permanent teeth,
and for the transitional changes occurring in the mixed
dentition stage 5. An accurate estimate of tooth
structure versus available space is necessary for
making competent decisions concerning eruption
guidance, serial extraction, space maintenance, space
regaining and other areas of orthodontic treatment
planning3.
Different methods for forecasting the sizes of
un-erupted teeth have been published. A review of the
literature using Medline search revealed that three
categories of methods are in use to estimate the mesio-
distal crown width of un-erupted maxillary or
mandibular canines and premolars in the mixed dentition
patients6.
These include direct measurement of the width
of permanent canine and (first and second) premolars
from dental radiographs7, 8,9,10,11,12,13 and use of tables to
predict the size of permanent canine and (first and
second) premolars based on their correlation to the
mesio-distal width of the mandibular permanent incisors4,
5,9,13,14,15,16
. It also includes a combination procedure
involving radiographic measurement of the width of un-
erupted first and second premolars plus the width of
erupted mandibular central and lateral incisor on the
same side to obtain a value that can be applied to a table
to get the predicted combined width of permanent
canines and (first and second) premolars11, 17.
African Health Sciences Vol 4 No 1 April 2004 63
 Of these methods it is argued that Moyer’s titles of articles and, where available, abstracts from
method is more widely used18, 19,20. This is
4
Medline search, full-length articles were analyzed. From
because Moyer’s method4 has minimal systematic the references in these articles other relevant literature
error and the range of such errors is known; can be was accessed through the Sir Albert cook library at the
used with equal reliability by the beginner and the Makerere Medical School. To be included in this meta-
expert, as it does not require sophiscated clinical analysis the article had to have: used Moyer’s method or
judgment and saves time. It requires no specific be very similar; a correlation coefficient and show the
equipment or radiographic projections; may be number of subjects; used simple regression analysis;
used for both arches and, although best done on used lower mandibular incisors to predict the canine and
dental casts, it can be done with reasonable premolar dimensions. Any articles comparing different
accuracy in the mouth. methods of mixed dentition analysis were excluded.
Although Moyer’s method has
advantages, it was developed on a Caucasian Table 1 The literature search strategy-Medline
population. The applicability of this method to
populations of other ethnic groups has been Number Request Records
studied and doubted18, 19,20,21. However no
statistical analysis of the findings of these studies 1 Mixed 101,106
is documented. A meta-analysis to assess the 2 Dentition 7,689
applicability of Moyer’s method in different ethnic 3 Mixed Dentitions 1,332
groups is presented. 4 Analysis 2,008,403
5 Mixed dentition 195
METHODOLOGY and analysis
The articles used in this meta-analysis were
obtained by a literature search of Medline (1966-
June 2003) using predetermined keywords
(table1). Using the
RESULTS
One hundred and ninety five articles were identified through a Medline search and ten from the
references of the full-length articles. Of these, seven fulfilled the inclusion criteria. The details are given
in table 2.

Table 2: Cited studies included in the meta-analysis.

Cited study Number Ethnic group Maxilla (r) Mandible (r)

Billard&Wylle9 441 Caucasian 0.64

Motakawa22 119 Japanese 0.66
Tanaka&Johnson14 506 Caucasian 0.625 0.648
Furguson etal18 105 American Blacks 0.630 0.706
Ziberman etal23 46 Israel 0.640 0.66
Keith20 46/51 (F?M) Hong Kong Chinese 0.79/0.65 F/M 0.77/0.69 F/M
Ver-der-merwe21 127/73 (F/M) South African (Whites) 0.72/0.56 F/M 0.70/0.68 F/M

r=coefficient of correlation

The findings of the met-analysis are given in table 3.

Table 3: The findings of the meta-analysis.

Subgroup r- r S2 S2 S P-value Degree of freedom

bar S2 e p p

Overall 0.655 0.001597 0.002116 -0.0052 12.07584 P=0.05 6

Maxilla 0.694 0.00436 0.004501 -0.0001 5.81208 P=0.05 2
Mandible 0.646 0.00104 0.001282 -0.0002 5.690461 P=0.05 2
r
r-bar=weighted mean correlation, variance, S2 sampling error,
 S 2= e=

S2 variance in the population correlation and S chi-square (for test of equality)

p= p=

African Health Sciences Vol 4 No 1 April 2004 64

 By pooling the data (table2) the The findings of this meta-analysis show that
variance in the population correlation differences may exist between correlation coeffi-
coefficient is not equal to 0. Using Hunter’s 24
significance test the null hypothesis (Ho: the
correlation coefficients are homogeneous) is
not rejected. This was done by using Chi
square statistics (p=0.05). So the null
hypothesis of equal population coefficients is
not rejected.
By taking the met-analysis further to
the subgroups of the Caucasian and the
Asians populations, they both had a p-value of
0.05. This implies that there may be variation
in the correlation coefficients of the
populations.

DISCUSSION
Meta-analyses can organize results and thereby fa-
cilitate new findings, or put old findings in a new
perspective28. However they also raise problems.
A frequent criticism is about the number of studies
included in the meta-analysis. In some cases there
a few studies that meet the inclusion criteria. For
ex-ample in the present study only seven studies
did. However inspection of the literature shows
that researchers start with a large number of
studies and then split them into smaller groupings.
For example Wright et al 29 analyzed 13 studies
and Tett et al 30 in one of the categories meta-
analyzed two studies. So the seven in the current
study are reasonable. This is because the analysis
gives a good blend of the data from different
articles and ethnicity in the current study.
In meta-analysis, well-defined criteria for
inclusion of studies are required. The selection of
studies is based on strict distinctions such as age.
However in the present study age was not consid-
ered since mixed dentition analysis is performed
on individuals in the same age bracket (the mixed
dentition stage). To avoid bias, the present
analysis was carried out considering only the
criteria for in-clusion. In addition the methods of
Hunter and Schumidt 26,27used in this meta-
analysis are adapted to correct for sources of error
such as sampling error and reliability of
measurement variables.
Since it became difficult to assess applica-
bility by using data from all the studies included at
once, subgroups of Caucasians 9,14,21and Asians20,22,23
were also meta-analyzed to try and find possible
variation within an ethnic group. The African18
popu-lation was not considered in this meta-analysis
be-cause only one study fulfilled the inclusion
criteria.
cients in different ethnic groups, since the p-value
was 0.05. This is in agreement with studies done on
Saudi Arabi-ans19 in which graphs showed
population differences from those derived from the
population used by Moyer. The review of Hunter 1
and other studies18, 19,20,21, which doubted the
applicability of the findings of Moyer’s study to other
ethnic groups are further supported by this study. It is
also possible that among the same ethnic groups there
are no significant differences in the correlation
coefficients. Since the findings from isolated studies
from populations such as Caucasians from South
Africa 21 suggest that more ac-curate prediction
results could be obtained from data and tables
developed from the population in question and not
universally applying Moyer’s method. As more
popula-tions are developing their own tables the
problem of ac-curacy will eventually be put to rest.
CONCLUSION
Variation in the correlation coefficients of
different populations using Moyer’s method
may fall either side. This implies that Moyer’s
method of prediction may have population
variations. For one to be sure of the accuracy
while using Moyer’s method it may be safer to
develop prediction tables for specific
populations. Thus Moyer’s method cannot
universally be applied without question.
African Health Sciences Vol 4 No 1 April 2004
REFERENCES
1. Hunter WS. Application of analysis of crowding and
spacing of the teeth. Dental Clinics of North America1978;
22: 563-577.
2. Huckaba G.W. Arch size analysis and tooth size
perdition. Dental Clinics of North America1964; 8: 431-440.
3. Smith HP, King DL and Valencia R. A comparison of
three methods of mixed dentition analyses. The Journal of
Pedodontics1979; 3(4): 291-302.
4. Staley RN, O’ Gorman TW, Hoag JF and Shelly TH.
Prediction of the widths of un-erupted canines and premolars.
Journal of American Dental Association 1984; 108(2):185-190.
5. Moyer RE. Handbook of orthodontics. 4 th ed. Chicago:
Year Book. 1998; 235-239.
6. Staley HP and Hoag J. Prediction of the mesio-distal
with of maxillary permanent canines and premolars.
American Journal of Orthodontics 1978; 73(2): 169-77.
7. Nance HN. The limitations of orthodontic treatment:
Mixed dentition diagnosis and treatment. American Journal
of Orthodontics1947; 33: 177-223.
8. Foster RR. and Wylie WL. Arch length deficiency in the
mixed dentition. American Journal of Orthodontics1958; 44:464-
476.
9. Ballard ML, and Wylie W. Mixed dentition case
analysis-estimating size of un-erupted permanent teeth.
American Journal of Orthodontics 1947; 33: 754-559.
10. Cohen M.E. Recognition of the developing
Malocclusion. Dental Clinics of North America1959; 6:
299-311.
65
11. Hixon EH and Old father RE. Estimation of the
size of un-erupted cuspid and bicuspid teeth. The
Angle Orthodontist 1958; 22:236-240.
12. Sim JM. Minor tooth movement in children. 2nd
ed. St. Louis: Mosby, 1977: 74-81.
13. Moorrees CFA and Reed RB. Correlation among
crown diameters of human teeth. Archives of Oral
Biology 1964; 9 : 685-697.
14. Tanaka MM and Johnston LE. The prediction of
un-erupted canines and premolars in a contemporary
population. Journal of American Dental Association
1974; 88(4): 798-801.
15. Brown JE. Predicting the mesio-distal crown
width of un erupted maxillary canines, first and
second premolars. M.S. Thesis, University of
Tennessee, School of Dentistry, Memphis, 1955.
16. Fonsenca CC. Predicting the mesio-distal crown
width of the canine-premolar segment of maxillary
dental arches. M.S. Thesis, University of Tennessee,
School of Dentistry, Memphis, 1961.
17. Stahle H. Determination of mesio-distal crown
width of un-erupted permanent cuspids and bicuspids.
Helv Odontol Acta 1959; 3:14-17.
18. Ferguson FS, Marco DJ, Sonnenburg EM and
Shakun M.L. The use of regression constants in
estimating tooth size in the Negro population.
American Journal of Orthodontics1978; 73(1): 68-72.
19. Al-Khadra BH. Prediction of the size of un-
erupted canines and premolars in a Saudi Arab
population. American Journal of Orthodontics and
Dentofacial Orthopedics 1993; 104(4): 369-372.
20. Yuen KK, Tang EL and So LL. Mixed dentition
African Health Sciences Vol 4 No 1 April 2004
analysis for Hong Kong Chinese. The Angle
Orthodontist 1998; 68(1): 21-28.
21. Van-der-Merwe SW, Rossouw P, Van-Wyk-Kotze TJ
and Trutero H. An adaptation of the mixed dentition space
analysis for a Western Cape Caucasian population. Journal
of Dental Association of South Africa 1991; 46 (9): 475-9.
22. Motokawa W, Onzaki M, Soejima Y and Yoshida Y. A
method of mixed dentition analysis in the mandible. Journal
of Dentistry for Children1987; 54(2):114-118.
23. ZibermanY, Koyoumdjisky KE and Vardimon A .
Estimation of mesio-distal width of permanent canines and
premolars in the early mixed dentition. Journal of Dental
Research1977; 56(8): 911-915.
24. Hunter JE. Met analysis. Sage Publications, Beverly
Hills.1982
25. Hunter JE and Schumidt FL. Methods of meta-analysis:
correcting error and bias in research findings. Sage,
California. 1990
26. Field A P. Meta-analysis of correlation coefficients: a
Monte Carlo comparison of fixed and random-effects
methods. Psychological Methods 2001;6(2),161-180
27. Rosenthal R. Writing met-analytical reviews.
Psychological Bulletin 1995; 118:183-192
28. Bardsen A. Risk periods associated with the development of
dental florosis in maxillary permanent central incisors: a meta-
analysis Acta Odontologisica Scandinevica.1999; 57:247-256.
29. Wright P, Lichtenfels PA, and Pursell ED. The
structured interview: Additional studies and a meta-analysis.
Journal of occupational psychology 1989;62: 191-199.
30. Tett RP, Jackson DN, and Rothstein M. Personal
measurers as predictors of job performance: A meta-
analytical review. Personal Psychology1991; 44: 703-741.
66
www.djas.co.in ORIGINAL ARTICLE
ISSN No-2321-1482

DJAS 2(II), 96-104, 2014

All rights are reserved

EVALUATION AND APPLICABILITY OF MOYERS MIXED DENTITION

ARCH ANALYSIS IN HIMACHAL POPULATION
1 2 3 4 5 6

Avninder Kaur , Reetu Singh , Sudhir Mittal , Sunila Sharma , Aditi Bector , Surabhi Awasthi
1
Professor & Head, Department of Pediatric and Preventive Dentistry, Bhojia Dental College and Hospital, Baddi, H.P., India.
2
Junior Resident, Department of Pediatric and Preventive Dentistry, Bhojia Dental College and Hospital, Baddi, H.P., India.
3
Prof. Department of Pediatric and Preventive Dentistry, Himachal Dental College, Sundernagar, H.P., India.
4,5
Sr. Lecturer, Department of Pediatric and Preventive Dentistry, Bhojia Dental College and Hospital, Baddi, H.P., India.
6
Junior Resident, Department of Pediatric and Preventive Dentistry, Bhojia Dental College and Hospital, Baddi, H.P., India.

ABSTRACT

Introduction: The determination of a tooth-size to arch length discrepancy in mixed dentition requires an
accurate prediction of the mesiodistal width of the unerupted permanent teeth. The Moyers mixed
dentition space analysis is the non-radiographic method for detecting tooth-size arch length discrepancies.
Moyers analysis was developed for North American children. Anthropological studies reveal that tooth
size varies among different races and ethnicities. Aim: The present study was aimed to determine the
applicability of Moyers mixed dentition arch analysis in children of Baddi, Himachal Pradesh. Materials
and methods: Dental study models of 120 children in age group of 13- 16 years, were analysed who
presented with complete eruption of permanent mandibular incisors, maxillary and mandibular canines &
premolars. All dentitions were required to be free of any signs of dental pathology or anomalies.
Measurements of the mesiodistal dimensions of the mandibular and maxillary teeth were made using a
digital caliper with a Vernier scale that was calibrated to the nearest 0.01mm. The values were then
subjected to statistical analysis. Results: All tooth groups showed highly significant differences
(p<0.001) between mesiodistal widths in male and female subjects. Significant differences (p<0.05) were
found between actual widths and the Moyers tables at almost all percentile levels, including the
recommended 75%. Conclusion: The differences noted between predicted values from the Moyers tables
and that of the present investigation might be the result of racial and ethnic diversity.
Key words: Arch length, Mixed dentition, Moyers analysis, Non- radiographic method, Tooth-size.

INTRODUCTION determination of tooth size arch length

Mixed dentition period is the most
dynamic phase in terms of changes in
occlusion and final outcome of dento-
skeletal relationship. During the mixed
dentititon period, the orthodontist or
paediatric dentist is often asked to provide
an accurate diagnosis and treatment of any
developing malocclusions. Early i n t e r v
e n t i o n o f t h e d e v e l o p i n g
malocclusions can be done by a proper
space assessment in mixed dentition
phase.1 Thus, mixed dentition arch
analysis forms an essential part of
Corresponding Author: diagnostic procedures. It is an important
Avninder Kaur
criterion in determining whether the
Mobile: +91-9814319434
E-mail: treatment plan is going to involve serial
avninder21@yahoo.com
extraction, guidance of eruption, space
Received: 26 April 2014 maintenance, space regaining or just
th
discrepancy in the mixed dentition
requires an accurate prediction of the
mesiodistal width of the unerupted
permanent teeth.
Various approaches have been applied to
estimatethemesiodistalcro
w n dimensions of unerupted maxillary
and mandibular canines & premolars in
mixed dentition patients.3 Statistical
methods employing linear regression
equations were first used by Moyers and
results were published in the form of the
well known Prediction tables in his
textbook in 1958.4
It is also noteworthy that Moyers has
provided two sets of data tables for mixed

Accepted: 30th July 2014 dentition space analysis, one for sexes
Online: 20th Sept 2014 periodic observation of the patient.2 The

96

combined given in 1973 , which does not correlate with
his sexes separated data published in 1988.6 Mixed
dentition analysis using Moyers tables is widely used 7-9
and has several advantages.10 It requires no specific
equipment or radiographic projections; used for both
arches and, is best done on dental casts. Moyers analysis
was however, developed from data obtained from North
American children. Anthropological studies reveal that
tooth size varies among different races and ethnicities.
So, there is a need for studying such racial trends and
verifying the authenticity of standard prediction tables
in different populations. The present study was
conducted with an aim to determine the applicability of
Moyers mixed dentition arch analysis in children of
Baddi. At the same time, new prediction equations were
also formulated with an objective to provide an accurate
mixed dentition analysis among Himachal population.
MATERIALS AND METHODS
A sample of 120 subjects in the age range of 13 –16
years were selected from various schools within 10
km radius from Bhojia Dental College and Hospital,
Baddi. The study was approved by institutional ethics
committee. After explaining the nature of the study,
permission was taken from the Principal of the
schools who in turn took permission from the parents
of selected children. Dental study casts of the selected
children were made from dental impressions taken
with alginate impression material (Marieflex,
Septodont Health Care India) and immediately
poured with dental stone (Gypstone, Type III, Prevest
Denpro Limited) to avoid any dimensional changes.
Inclusion criteria for sample selection were the
following:
1.Fully erupted mandibular permanent incisors,
mandibular and maxillary permanent canines and
premolars.
2.No obvious loss of tooth material mesiodistally as a
result of caries, fractures, congenital defects, or inter
proximal attrition.
3.No previous history of orthodontic treatment.
4.Similar ethnic background.
5.Subjects with no or minimal crowding.
6. The dental impressions and study casts were of high
97
Dental Journal of Advance Studies Vol. 2 Issue II- 2014
quality and free of distortions.
Exclusion criteria for sample selection were:
1. Physically or medically compromised children
2. Migratory population
The teeth measured were the mandibular permanent
central and lateral incisors, the mandibular and
maxillary permanent canines, and first and second
premolars of both arches. The values obtained for the
right and left canine premolar segments in each arch
were averaged, so that there would be one value for the
mandibular canine- premolar segment (LCPMs) and one
value for the maxillary canine-premolar segment
(UCPMs) for each value of the combined mandibular
incisors (LI). Measurements of the mesiodistal crown
dimensions of the mandibular and maxillary teeth were
made by using a digital caliper with a Vernier scale
(Aerospace industries - Figure 1), calibrated to the
nearest 0.01 mm. The tips of the calipers were precision
engineered to ensure the greatest accuracy while
measuring the various tooth groups. A standardized
method proposed by Moorrees and Reed11 was used to
measure the mesiodistal crown dimensions. The greatest
mesiodistal crown dimension of each tooth was
measured between its contact points, with the sliding
caliper placed parallel to the occlusal and vestibular
surfaces.
Figure 1: Measurement of M-D crown dimensions.
RESULTS
A total of 120 sets of dental casts were obtained from
66 male subjects and 54 female subjects with the mean
age of 14.20+1.166 years and 14.33+166 years,
respectively. Descriptive statistics, including the mean,
standard deviation, and minimum and maximum values
of mesiodistal dimensions of mandibular

incisors, maxillary and mandibular canines and
premolars were calculated. The mesiodistal crown
dimensions of mandibular incisors ranges from
18.64–25.36 mm and 17.92 – 25.50 mm separately
for males and females, respectively. Mesiodistal
dimensions of the maxillary canine & premolars for
the males and females ranges from 18.07 -23.29 mm
and 17.18 – 23.18 mm, respectively and mesiodistal
crown dimensions of the mandibular canine &
premolars were 18.17-22.5 and 17.38-22.42 for males
and females, respectively.
Mandibular incisors mesiodistal crown dimensions for
the males showed a mean of 22.339±1.4644 and for
females, it was found to be 21.504±1.5140 (t=3.127).
Means for mesiodistal crown dimensions of maxillary
canine & premolars for males was 20.64±1.008 and for
females, it was 19.88±1.17 (t=3.762). Means for
mesiodistal crown dimensions of mandibular canine &
premolars for males and females were 20.365±1.0235
and 19.45±1.164, respectivly (t=4.606).
All the three tooth groups (LI, UCPMs and LCPMs)
showed sexual dimorphism with significant
differences in the mesiodistal crown dimensions for
males and females.
These data were then used to develop regression
equations
y = a + bx
a and b are regression coefficients
y = dependent variable (predicted width of canine and
premolars)
x = independent variable (summed width of
mandibular incisors)
The coefficient of co-relation(r) was derived to find the
co-relation between the sums of canine and premolars in
both the arches with that of sum of mandibular incisors.
The coefficient of determination (r2) was found to
determine the accuracy of the formulated regression
equations [Table 1]. The standard error of estimate
(SEE) was calculated to determine the validity of the
proposed equations. Student's unpaired t-test was
applied to compare tooth dimensions between male and
female subjects. The actual measurements were
98
Dental Journal of Advance Studies Vol. 2 Issue II- 2014
compared with the predicted values obtained with the
Moyers probability tables at the 35th, 50th, and 75th
percentile confidence levels [Table 2-5]. P- value of
≤ 0.05 was considered statistically significant.
With the help of the data obtained, new regression
equations were derived separately for male and female
subjects to be used to predict tooth dimension.
Male: Maxilla - y = 10.761 + 0.442 (x)
Mandible – y = 9.524 + 0.485 (x)
Female:
Maxilla – y = 10.135 + 0.442 (x)
Mandible – y = 9.142 + 0.479 (x)
DISCUSSION
In this study, Himachal population is chosen for the
study which is racially different from the population
selected by Moyers for making prediction tables. It has
also been well established in the literature that tooth
sizes vary considerably between racial groups,
therefore, the accuracy of these prediction methods
might be in question when applied to population
groups other than white people.7,11-17 Nanda and
Chawla18 found a significant disparity between the
leeway space of North Indian children and the leeway
space that was reported by Nance 19 for American
children. Singh and Nanda20 derived a mixed dentition
prediction scale for North Indian population which is
different from prediction tables developed by Ballard
and Wylie21 for American white people. The reasons
for the tooth size variation in different racial groups
have not been clearly elucidated, but obviously, genetic
factors play a major role. Nutrition and environmental
exposure during tooth development might have
secondary role.
The use of digital calipers has been shown to be more
accurate method of measuring mesiodistal tooth
dimension on dental study models. Hence, they were
chosen for this study. The excellent measurement
accuracy reduces the possibility of introducing
systemic and random errors in measurements. This
method was reported to be highly reproducible and

accurate for measuring mesiodistal crown widths by
Doris et al.22 For measurement reliability, teeth were
measured manually and independently by two
investigators and mean of 2 values was taken.
In addition to the racial difference in tooth size, the
descriptive statistics showed that the mesiodistal crown
widths of all tooth groups measured in this study were
significantly larger in males than in females (p<0.001).
Similar sex dimorphisms in tooth sizes have been noted
in other odontometric studies.13-17, 23 The significant sex
difference in mesiodistal tooth dimensions emphasizes
the importance of developing mixed dentition prediction
aids separately for male and female patients, so that a
more accurate tooth size prediction can be made during
the mixed dentition period. This sex difference in tooth
sizes was also considered by Moyers 5,6 while modifying
his original probability
tables that were based on pooled odontometric data.
The correlation coefficients obtained in this study
(Table 1) are similar to those of several other studies;
Hixon and Oldfather24 (0.69), Tanaka and Johnston 25
(0.65), Ballard and Wylie21 (0.64), and Lee-Chan et al15
(0.66). Relatively consistent correlations (0.60-0.70),
were found between the combined mesiodistal widths
of the mandibular permanent incisors and that of the
canine premolars segment. This may implicate that
60% to 70% of the polygenes that determine tooth
size are shared between the mandibular incisors and
the canines and the premolars. 25 This common genetic
code gives theoretical justification for the estimation
of unerupted canine & premolar widths based on the
mesiodistal dimensions of already erupted
mandibular incisors, even though these teeth belong
to different morphologic classes. Using the
mandibular permanent incisors as a predictor variable
has several advantages: they erupt early in the mixed
dentition, can be easily measured, show little
variability in size, and are directly in the midst of
most space-management problems.6
Coefficients of determination, which indicate the
predictive accuracy of the regression equations, were
between 0.36 and 0.47 for the different canine premolar
100
Dental Journal of Advance Studies Vol. 2 Issue II- 2014
segments (Table 1). This means that 36% to 47% of
the total variances in canine-premolar widths are
accounted for by knowing the combined mandibular
incisor widths. The error involved in the use of the
regression equations is indicated by the SEE; the
lower the SEE, the better the prediction equation.
The new mixed dentition prediction aids (regression
equations and probability tables) developed in this
study are presented in Tables 2, 3, 4 and 5. The use
of these prediction aids for estimation of unerupted
canine- premolar widths is likely to result in a more
accurate mixed dentition space analysis among
Himachal children.
Significant differences (p<0.05) were found between
the predicted mesiodistal tooth dimensions in the
present study and that of the Moyers probability tables
at almost all percentile confidence levels. This study
revealed that the Moyers charts at the 75th and 50th
percentile confidence level overestimates tooth
dimensions. When actual values were compared with
Moyers chart at the 35th percentile, it showed varied
results. Al- Khadra8 found that the recommended 75%
confidence level of the Moyers probability tables
overestimated the sizes of canines and premolars of a
Saudi Arab population. Probability tables on the
Moyers pattern have also been derived by Priya and
Munshi14 (South Indians), Schirmer16 (black South
Africans) and Singh and Singla 2 6 (Himachal
population, North India) and Philip and Prabhakar 27
(Punjab population, North India). Priya and Munshi 14
concluded that the Moyers probability tables
underestimated the tooth sizes of South Indian
children. Schirmer16 tested the applicability of the
Moyers tables in black South Africans and found
highly significant differences (p<0.001) at all
percentile confidence levels, in the arches of both male
and female subjects, except at the 75%, 85%, and 95%
levels in the maxillary arch of females. Singh and
Singla conducted a study in the population from the
interior of Himachal state and they concluded that the
Moyers tables tend to underestimate the mesiodistal c a
nine-premolarwidths,includingatth
e recommended 75% level.26 Philip and Prabhakar
also found significant differences (p<0.05) between the
 Dental Journal of Advance Studies Vol. 2 Issue II- 2014

predicted mesiodistal tooth widths of their study and
that of the Moyers probability tables at almost all
percentile confidence levels.27 They concluded that
the Moyers tables tend to underestimate the
mesiodistal canine-premolar widths including at the
recommended 75% and 50% levels.
The present study showed that mesiodistal dimensions
of permanent canine & premolars calculated from
sum of permanent mandibular incisors more closely
approximate at 35th percentile compared to 75th
percentile level of probability as suggested by
Moyers. Rani and Goel28 also showed that 35th
percentile is more accurate than 75th percentile level
of probability suggested by Moyers in South Indian
population.

Table 1: Regression parameters for prediction of mesiodistal dimensions of canine premolar segments
based on the sum of mandibular incisors
2
r (coefficient of Regression r (coefficient of SEE (standard
Tooth group Sex error of estimate)
correlation) constants determination)

a b

UCPM (Maxillary M 0.652 10.761 0.442 0.425 1.439

canine and F 0.600 10.135 0.455 0.360 1.813
premolars)

LCPM( M 0.685 9.524 0.485 0.470 1.441

Mandibular F 0.637 9.142 0.479 0.406 1.733
canine and
premolars)

Table 2: Actual value and Predicted values at 35th, 50th and 75th percentiles of Moyers chart
for Males in mandibular arch

LI (sum of Predicted values at Actual

mandibular value
35th th 75th
50
incisors) (LCPM)
percentile percentile percentile

19.5 19.0 19.5 20.4 19.60

20 19.3 19.7 20.6 18.395

20.5 19.5 20.0 20.8 18.95

21 19.7 20.2 21.0 19.87

21.5 20.0 20.4 21.2 19.65

22 20.2 20.6 21.4 20.45

22.5 20.4 20.9 21.6 20.55

23 20.67 21.1 21.9 20.50

23.5 20.9 21.3 22.1 21.37

24 21.1 21.5 22.3 21.11

24.5 21.3 21.7 22.5 20.49

25 21.5 22.0 22.8 21.72

25.5 21.7 22.2 23.0 22.49

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Table 3: Actual value and Predicted values at 35th, 50th and 75th percentiles of Moyers chart for
Males in maxillary arch

LI (sum of Predicted values at Actual

mandibular value
th
incisors) 35 percentile 50
th
percentile 75th percentile (UCPM)

19.5 19.3 19.7 20.3 18.07

20 19.6 19.9 20.5 19.50

20.5 19.9 20.2 20.8 19.34
21 20.1 20.4 21.0 20.36

21.5 20.4 20.7 21.3 20.00

22 20.6 20.9 21.5 20.84

22.5 20.9 21.2 21.8 21.00

23 21.1 21.5 22.0 21.14
23.5 21.4 21.7 22.3 21.35

24 21.6 22.0 22.5 21.15

24.5 21.9 22.2 22.8 21.04

25 22.1 22.5 23.0 20.73

25.5 22.4 22.7 23.3 23.30

Table 4 : Actual value and Predicted values at 35th, 50th and 75th percentiles of Moyers chart for
Females in mandibular arch

LI (sum of Predicted values at Actual

mandibular 35th 50th 75th value

incisors) percentile percentile percentile (LCPM)

19.5 18.2 18.7 19.6 18.33

20 18.5 19.0 19.8 18.78

20.5 18.8 19.2 20.1 19.07

21 19.0 19.5 20.3 19.24
21.5 19.3 19.8 20.6 21.8
22 19.6 20.0 20.8 19.75

22.5 19.8 20.3 21.1 20.27

23 20.1 20.5 21.3 18.77

23.5 20.3 20.8 21.6 20.24
24 20.6 21.1 21.9 22.03
24.5 20.9 21.3 22.1 20.88
25 21.1 21.6 22.4 21.30

25.5 21.4 21.8 22.7 20.51

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Table 5 : Actual value and Predicted values at 35th, 50th and 75th percentiles of Moyers chart
for Females in maxillary arch

Predicted values at
LI (sum of Actual

mandibular 35th 50th 75th value

incisors) (UCPM)
percentile percentile percentile

19.5 19.2 19.6 20.4 18.64

20 19.4 19.8 20.5 19.51

20.5 19.5 19.9 20.6 19.74

21 19.7 20.1 20.8 19.81

21.5 19.8 20.2 20.9 19.75

22 19.9 20.3 21.0 19.64

22.5 20.1 20.5 21.2 20.20

23 20.2 20.6 21.3 20.78

23.5 20.4 20.8 21.5 21.49

24 20.5 20.9 21.6 22.09

24.5 20.6 21.0 21.8 20.58

25 20.8 21.2 21.9 21.75

25.5 20.9 21.3 22.1 20.30

canine and premolars in Himachal population,

therefore these prediction methods are not
completely applicable in this population.
The observation of present study reaffirm that the
2) Moyers chart at 35th percentile confidence level
Moyers probability tables overestimate tooth sizes of
gives more appropriate estimate of width of
unerupted canine and premolars of Himachal
unerupted canine and premolars as compared to 75th
population. Developing new probability tables on the
percentile confidence level.
Moyers pattern, specifically for different population
groups, can aid in achieving more accurate estimation
of unerupted tooth sizes, thus enabling clinicians in
early diagnosis and timely intervention of developing
malocclusions.

CONCLUSION
The following conclusions were drawn from
this study -
1) The prediction methods suggested by Moyers
over estimated the actual tooth size of unerupted

The newly formed regression equations provided
more precise results. Further studies on a larger
population are recommended to get a more accurate
result.
REFERENCES
1. Abu Alhaija ES, Qudeimat MA. Mixed dentition space
analysis in a Jordanian population: comparison of two methods.
Int J Paediatr Dent. 2006;16(2):104-10.
2. Bishara, S. E., Staley, R. N. Mixed-dentition mandibular
arch length analysis: A step-by-step approach using the revised
Hixon-Oldfather prediction method. Am J Orthod. 1984;86:130-
35.
103
3. Staley RN, Hoag JF. Prediction of the mesiodistal widths of
maxillary permanent canines and premolars. Am J Orthod.
1978;73(2):169-77.
4. Moyers RE. Handbook of orthodontics. 4th edn. Chicago:
Year Book Medical Publishers; 1958.
5. Moyers RE. Analysis of dentition and occlusion. In: Moyers
RE, editor. Handbook of orthodontics. 3rd ed. Chicago:
Year Book Medical Publishers; 1973.
6. Moyers RE. Analysis of dentition and occlusion. In: Moyers
RE editor. Handbook of orthodontics. 4th ed. Chicago:
Year Book Medical Publishers; 1988:p. 235-40.
7. Ferguson FS, Marco DJ, Sonnenburg EM and Shakun M.L.
The use of regression constants in estimating tooth size in the
Negro population. American Journal of Orthodontics.
1978;73(1):68-72.

8. Al-Khadra BH. Prediction of the size of un-erupted canines
and premolars in a Saudi Arab population. Am J Orthod
Dentofacial Orthop. 1993;104(4):369-372.
9. Yuen KK, Tang EL and So LL. Mixed dentition analysis for
Hong Kong Chinese. The Angle Orthodontist. 1998;68(1):21-28.
10. Proffit WR, Fields HW. Contemporary orthodontics (3rd
ed). St Louis, Mo: Mosby; 1961;p167-70.
11. Bishara SE, Jakobsen JR, Abdallah EM, Fernandez Garcia
A. Comparisons of mesiodistal and buccolingual crown
dimensions of the permanent teeth in three populations from
Egypt, Mexico, and the United States. Am J Orthod Dentofacial
Orthop. 1989;96:416-22.
12. Lavelle CLB. Maxillary and mandibular tooth size in
different racial groups and in different occlusal categories. Am J
Orthod. 1972;61:29-37.
13. Jaroontham J, Godfrey K. Mixed dentition space analysis in
a Thai population. Eur J Orthod. 2000;22:127-34.
14. Priya S, Munshi AK. Formulation of a prediction chart for
mixed dentition analysis. J Indian Soc Pedod Prev Dent.
1994;12:7-11.
15. Lee-Chan S, Jacobson BN, Chwa KH, Jacobson RS. Mixed
dentition analysis for Asian-Americans. Am J Orthod Dentofacial
Orthop. 1998;113:293-9.
16. Schirmer UR, Wiltshire WA. Orthodontic probability tables for
black patients of African descent: mixed dentition analysis. Am J
Orthod Dentofacial Orthop. 1997;112:545-51.
17. Diagne F, Diop-Ba K, Ngom PI, Mbow K. Mixed dentition
analysis in a Senegalese population: elaboration of prediction tables.
Am J Orthod Dentofacial Orthop. 2003;124:178-83.
18. Nanda RS, Chawla JM. Variability of leeway space. J Indian
Dent Assoc 1973;45:99-108.
Source of Support: Nil, Conflict of Interest: None Declared
104
Dental Journal of Advance Studies Vol. 2 Issue II- 2014
19. Nance HV. Limitations of orthodontic treatment. Mixed
dentition diagnosis and treatment. Am J Orthod Oral Surg.
1947;33:177-223.
20. Singh M, Nanda RS. Prediction of tooth size and its clinical
application. J Indian Dent Assoc. 1972;44:5-8.
21. Ballard ML,Wylie WL. Mixed dentition case analysis:
estimating sizes of unerupted permanent teeth. Am J Orthod.
1947;33:754-9.
22. Doris JM, Bernard BW, Kuftinec MM, Stom D.A
biometric study of tooth size and dental crowding.Am J Orthod.
1981;79:326-35.
23. de Paula S, Almeida MA, Lee PC. Prediction of
mesiodistal diameter of unerupted lower canines and premolars
using 45 degrees cephalometric radiography. Am J Orthod
Dentofacial Orthop. 1995;107:309-14.
24. Hixon EH, Oldfather RE. Estimation of the sizes of
unerupted cuspids and bicuspids. Angle Orthod. 1958;28:236-
40.
25. Tanaka MM, Johnston LE. The prediction of the sizes of
unerupted canines and premolars in a contemporary orthodontic
population. J Am Dent Assoc. 1974;88:798-801.
26. Singh V, Singla A, Mahajan V, Jaj HS, Bawa T.
Development Of A Prediction Equation For The Mixed
Dentition In A Himachal Population. Indian journal of Dental
Sciences. 2013;5:40-43.
27. Philip N.I, Prabhakar M, Arora D, Chopra S. Applicability
of the Moyers mixed dentition probability tables and new
prediction aids for a contemporary population in India. Am J
Orthod Dentofacial Orthop. 2010;138:339-45
28. Rani MS, Goel. Evaluation of Moyers mixed dentition
analysis for south Indian population. J Indian Dent Assoc
1989;60:253-55.