Facultiy of dentistry Kufa university ORTHODONTICS Space Analysis It is important to quantify the amount of crowding within the arches, because treatment varies depending on the severity of the crowding. Space analysis, using the dental casts, is required for this purpose. A space analysis should be performed during the mixed dentition to determine if the permanent teeth have adequate space in which to erupt. Principles of Space Analysis: Space analysis requires a comparison between the amounts of space available for the alignment of the teeth and the amount of space required to align them properly. The analysis can be done either directly on the dental casts or by a computer algorithm after appropriate digitization of the arch and tooth dimensions. Whether the space analysis is done manually or in the computer, the first step is calculation of space available: This is accomplished by measuring arch perimeter from the mesial of one first molar to the other, over the contact points of posterior teeth and incisal edge of anteriors . There are two basic ways to accomplish this manually: (1) by dividing the dental arch into segments that can be measured as straight line approximations of the archay Facultiy of dentistry SEZ Kufa university (2) by contouring a piece of wire (or a curved line on the computer screen) to the line of occlusion and then straightening it out for measurement. The first method is preferred for manual calculation because of its greater reliability. Either method can be used The second step is to calculate the amount of space required for alignment of the teeth: This is done by measuring the mesiodistal width of each erupted tooth from contact point to contact point, estimating the size of unerupted permanent teeth, and then summing the widths of the individual teethFacultiy of dentistry Kufa university If the sum of the widths of the permanent teeth is greater than the amount of space available, there is an arch perimeter space deficiency and crowding would occur. If available space is larger than the space required (excess space), gaps between some teeth would be expected. Space analysis carried out in this way is based on three important assumptions: (1) The anteroposterior position of the incisors is correct (i.e., the incisors are neither excessively protrusive nor retrusive): There is an interaction between crowding of the teeth and protrusion or retrusion: if the incisors are positioned lingually (retruded), this accentuates any crowding; but if the incisors protrude, the potential crowding will be atFacultiy of dentistry Kufa university least partially alleviated. Crowding and protrusion are really different aspects of the same phenomenon. If there is not enough room to properly align the teeth, the result can be crowding, protrusion, or (most likely) some combination of the two. (2) The space available will not change because of growth: Ina child with a well-proportioned face, there is little or no tendency for the dentition to be displaced relative to the jaw during growth, but the teeth often shift anteriorly or posteriorly in a child with a jaw discrepancy. For this reason, space analysis is less accurate and less useful for children with skeletal problems (Class II, Class III, long face, short face) than in those with good facial proportions. (3) All the teeth are present and reasonably normal in size: The third assumption can (and must) be checked by clinical and radiographic examination, looking at the teeth as a set rather than as individual units. Anomalies in tooth size have significant implications for space in the dental archesFacultiy of dentistry Kufa university Estimating the Size of Unerupted Permanent Teeth: There are three basic approaches to doing this: 1. Measurement of the teeth on radiographs: This requires an undistorted radiographic image, which is more easily achieved with individual periapical radiographs than with panoramic radiographs. Even with individual radiographs, it is often difficult to obtain an undistorted view with any type of radiograph, it is necessary to compensate for enlargement of the radiographic image. This can be done by measuring an object that can be seen both in the radiograph and on the casts, usually a primary molar tooth. A simple proportional relationship can then be set up: True width of primary molar = —_ True width of unerupted premolar Apparent width of primary molar Apparent width of unerupted premolarFacultiy of dentistry Kufa university 2. Estimation from proportionality tables: There is a reasonably good correlation between the size of the erupted permanent incisors and the unerupted canines and premolars. These data have been tabulated for white American children by Moyers. To utilize the Moyers prediction tables, the mesiodistal width of the /ower incisors is measured and this number is used to predict the size of both the lower and upper unerupted canines and premolars. Moyers Prediction Values (75% level) Total mandibular-incisor width m5 no a5 no 25 Ba Predicted width of Manila 206 209 212 213 18 220 23 226 canine and premolars — Mandible 201 204 207 21.0 a3 21.6 21.9 22 Tanaka and Johnston developed another way to use the width of the lower incisors to predict the size of unerupted canines and premolars. For children from a European population group, It requires neither radiographs nor reference tables (once the simple equation is memorized), 6Facultiy of dentistry Kufa university which makes it very convenient. The method, however, is less accurate for other population groups, and appears to have systematic errors for specific race and gender. TANAKA AND JOHNSTON PREDICTION VALUES One halfofthe +105m = estimated width of mandi- mesiodistal bular canine and premolars width ofthe in one quadrant four lower +11.0mm = estimated width of maxillary incisors canine and premolars in one quadrant 3. Combination of radiographic and prediction table methods. Since the major problem with using radiographic images comes in evaluating the canine teeth, it would seem reasonable to use the size of permanent incisors measured from the dental casts and the size of unerupted premolars measured from the radiographs to predict the size of unerupted canines. A graph developed by Staley and Kerber from Iowa growth data allows canine width to be read directly from the sum of incisor and premolar widths.Shy Facultiy of dentistry Kufa university 24 25 26 27 28 29 30 3 (mm) ‘Sum of tooth numbers 25, 26, X28, X29 of sum of 23, 24, X20, X21 HB Graph showing relationship between size of lower incisors measured from cast plus lower first and second premolars measured from radiographs (x-axis) and size of canine plus premolars (y-axis). (Redrawn from Staley RN, Kerber RE. Am J Orthod 78:296-302, 1980.) Which of these methods is best for an individual patient depends on the circumstances. If the patient fits this population group, the Staley-Kerber method will give the best prediction, followed by the Tanaka- Johnston and Moyers approaches These methods are superior to measurement from radiographs. On balance, the Tanaka- Johnston method probably is most practical for manual calculation because no radiographs are required and the simple ratio can beFacultiy of dentistry Kufa university printed right on the space analysis form, so that no reference tables must be consulted. On the other hand, if the patient does not fit the population group, as an African or Asian child, direct measurement from the radiographs is the best approach. If obvious anomalies in tooth size or form are seen in the radiographs, the correlation methods (which assume normal tooth size relationships) should not be used. References: ¢ Contemporary orthodontics 2013