diagnostics
Article
Characteristics of Mandibular Arch Forms in Patients with
Skeletal Mandibular Prognathism
Erika Ichikawa 1,† , Chie Tachiki 1, *,† , Kunihiko Nojima 2 , Satoru Matsunaga 3 , Keisuke Sugahara 4 ,
Akira Watanabe 5 , Norio Kasahara 6 and Yasushi Nishii 1
Citation: Ichikawa, E.; Tachiki, C.;
Nojima, K.; Matsunaga, S.;
Sugahara, K.; Watanabe, A.;
Kasahara, N.; Nishii, Y.
Characteristics of Mandibular Arch
Forms in Patients with Skeletal
Mandibular Prognathism. Diagnostics
2023, 13, 3237. https://doi.org/
10.3390/diagnostics13203237
Academic Editors: Małgorzata
Zadurska and Ewa Czochrowska
Received: 5 September 2023
Revised: 10 October 2023
Accepted: 16 October 2023
Published: 17 October 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Diagnostics 2023, 13, 3237. https://doi.org/10.3390/diagnostics13203237
1 Department of Orthodontics, Tokyo Dental College, Chiyoda, Tokyo 101-0061, Japan;
ichikawaerika@tdc.ac.jp (E.I.); nishii@tdc.ac.jp (Y.N.)
2 Fujiseki Dental Clinic, Chiyoda, Tokyo 101-0041, Japan
3 Department of Anatomy, Tokyo Dental College, Chiyoda, Tokyo 101-0061, Japan; matsuna@tdc.ac.jp
4 Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Chiyoda,
Tokyo 101-0061, Japan; ksugahara@tdc.ac.jp
5 Department of Oral & Maxillofacial Surgery, Tokyo Dental College, Chiyoda, Tokyo 101-0061, Japan;
akirawat@tdc.ac.jp
6 Department of Histology and Developmental Biology, Tokyo Dental College, Chiyoda, Tokyo 101-0061, Japan;
nkasahara@tdc.ac.jp
* Correspondence: tachikichie@tdc.ac.jp
† These authors contributed equally to this work.
Abstract: Arch forms in orthodontics are considered to affect occlusal stability. This study’s subjects
were 47 patients (Class III S group) who visited the Chiba Dental Center of Tokyo Dental College
and were surgical orthodontic cases, and 60 patients with Class I malocclusion were selected as the
control group. A mandibular model of each subject was plotted with each tooth on a digitizer. The
clinical bracket points of each tooth were plotted, and intercanine and intermolar measurements
were taken. The least squares method was used to fit a quartic equation, and the arch form was
drawn. The Class IIIS group was divided by Wits appraisal and facial pattern into a dolichofacial or
brachyfacial pattern, and arch forms were compared. The results show that the Class IIIS group had
a significantly smaller intermolar width, canine depth, and molar depth and a significantly larger
canine W/D ratio. In those with a dolichofacial pattern, the anterior curve of the arch form tended
to be flat and the posterior curve narrower. This is because, in skeletal mandibular prognathism,
the mandibular anterior shows lingual tipping, and the molars show palatal tipping due to dental
compensation, and it was inferred that this tendency was higher in high-angle cases.
Keywords: arch form; skeletal mandibular prognathism; surgical orthodontics; facial pattern
1. Introduction
Surgical orthodontic treatment can be applied to severe skeletal mandibular prog-
nathism to improve the three-dimensional disharmony of the upper and lower jaws as well
as construct a functional occlusion [1]. When using cephalometric X-rays, dental models,
and computed tomography (CT), it is necessary to set highly accurate goals for preopera-
tive orthodontic treatment, such as harmonization of the maxillary and mandibular dental
arch forms, optimization of the dental axis inclination of the anterior teeth for each jaw
(dental decompensation), and prediction of the direction and amount of movement of the
maxillary and mandibular bones. In addition, it is now possible to accurately simulate
postoperative facial changes, and morphological restoration has evolved even further than
before. However, from the perspective of maintaining and stabilizing occlusion, many
issues, such as postoperative relapse, remain.
In orthodontic treatment, there is a consensus that the determination of a patient’s
post-treatment arch form not only satisfies esthetic requirements but also contributes to
occlusal stability by maintaining the original mandibular intercanine width to prevent
https://www.mdpi.com/journal/diagnostics
Diagnostics 2023, 13, 3237 2 of 9

relapse and keep the original arch form unchanged [2]. Clinically, it is considered useful to
determine the arch form for a pre-treatment mandibular dental model. Therefore, many
studies have been conducted on arch form differences by ethnicity [3–7] and malocclusion
type [8–11] in orthodontically treated patients. On the other hand, there are few reports
of arch forms of cases with skeletal deviation. Since such cases are often treated clinically,
it is meaningful to investigate these issues. Therefore, the present study was designed to
characterize the arch form of the mandible in skeletal mandibular prognathism.

2. Materials and Methods

2.1. Subjects
The subjects were 47 patients with skeletal mandibular prognathism (Class IIIS group)
who visited the Chiba Dental Center of Tokyo Dental College between 2015 and 2023. The
inclusion criteria were diagnosis of mandibular prognathism requiring surgical orthodontic
treatment and an arch length discrepancy of 4 mm or less. The exclusion criteria were
abnormal tooth morphology or missing teeth, a menton (the extreme inferior point of the
chin) deviation of 4 mm or more, restorations extending to the contact point, cusp tips and
incisal edges, and a history of orthodontic treatment or congenital disease. Two individuals
with more than 10 years of experience in orthodontic treatment were involved in the
diagnoses. Cephalometric radiographs of the subjects were analyzed to measure the
ANB (an item evaluating the anteroposterior position of the maxillary and mandibular
alveolar bases) angle and perform Wits appraisal (an item evaluating the anteroposterior
relationship of the maxilla and mandible) to assess anteroposterior skeletal positioning.
The facial pattern was comprehensively determined from the results of Ricketts’ analysis
of the facial axis, mandibular plane angle, lower facial height, mandibular arc, and total
facial height, which were used to determine the vertical position of the mandible. For each
measurement, ±1 SD from the standard value was divided into three parts, with −0.5
for 1/3 SD in the dolicho tendency, 0 for 1/3 SD in the center, and +0.5 for 1/3 SD in the
brachy tendency. More than ±1 SD but less than ±2 SD was set to ±1, more than ±2 SD
but less than ±3 SD was set to ±1.5, more than ±3 SD but less than ±5 SD was set to ±2.5,
and more than ±4 SD was set to ±3. The cumulative total for each item was classified as
follows: −3.0 or less was classified as a dolichofacial pattern (high-angle cases), −2.5 to
+2.5 as a mesiofacial pattern, and +3 or more as a brachyfacial pattern (low-angle cases).
The subjects’ characteristics are shown in Table 1.

Table 1. Patients‘ characteristics (n = 47).

Male: 18
Sex
Female: 29
Age (year) 24.3 ± 9.7
ANB (◦ ) −2.5 ± 2.2 Max.: 0 Min.: −5.5
Wits appraisal (mm) −12.6 ± 4.5 Max.: −6 Min.: −25
Facial pattern Brachy: 24 Mesio: 13 Dolicho: 10

The control group consisted of 60 patients (27 males and 33 females; mean age
16.3 years) diagnosed with Class I malocclusion who underwent orthodontic treatment at
the same institution. The inclusion criteria were molar relationship Class I, skeletal Class
I, and a menton deviation within 4 mm. Pre-treatment mandibular dental arch models of
these subjects were used.

2.2. Measurement Method

The occlusal planes of the mandibular models were photocopied with a ruler included
for magnification correction. The photocopied images were placed in a digitizer (DigitizerII,
Wacom, Saitama, Japan), and most facial portions of 13 proximal contact areas around the
arch were digitized and set as the coordinate origin between the central incisors (point 7).
A line (Line A) connecting the contact points of the first and second premolars (point 3 and
point 11) on both sides was drawn, and another line (Line B) connecting the contact points of
 (DigitizerII, Wacom, Saitama, Japan), and most facial portions of 13 proximal contact areas
around the arch were digitized and set as the coordinate origin between the central inci-
sors (point 7). A line (Line A) connecting the contact points of the first and second premo-
Diagnostics 2023, 13, 3237 3 of 10
lars
Diagnostics (point
2023, 13, 32373 and point 11) on both sides was drawn, and another line (Line B) connecting 3 of 9
the contact points of the second premolar and first molar (point 2 and point 12) was also
drawn. The X-axis (DigitizerII,
was set to Wacom,
be parallel to the average of the slopes of these two lines, and
Saitama, Japan), and most facial portions of 13 proximal contact areas
the perpendicular around the second
line to the premolar
it was and first(Figure
molar (point 2 and point 12) was also drawn. Thecorre-
X-axis was
archthewere Y-axis
digitized and set 1).asTwelve clinical
the coordinate bracket
origin betweenpoints
the central inci-
set to be parallel to the average of the slopes of these two lines, and the perpendicular line to
sponding to the bracket and tube attachment position of each tooth were set as
sors (point 7). A line (Line A) connecting the contact points of the first and second premo- representa-
it was the Y-axis (Figure 1). Twelve clinical bracket points corresponding to the bracket and
tive points for eachlars tube
(point
tooth [3].3 A
and
attachment
point
line 11) on boththe
connecting
position
sides was drawn,
of each toothmesial
were set and and another
distal contact
as representative
linepoints
(Line B)ofconnecting
points for each each
tooth [3].
tooth (embrasure line) the contact
was points
drawn on of the second premolar and first molar (point 2 and point 12) was also
A line connecting the the
mesialcoordinates. For incisors,
and distal contact points of canines,
each toothand bicuspids,
(embrasure line) was
drawn. The X-axis was set to be parallel to the average of the slopes of these two lines, and
a line perpendicular drawn
to on embrasure
the the coordinates. lineForwasincisors,
drawn canines,
fromand thebicuspids,
middle aof
line
theperpendicular
embrasure to the
the perpendicular
embrasure line to
line was drawnto it was
from the Y-axis
the (Figure
middle of the 1). Twelve clinical bracket points corre-
line, and for molars, a line perpendicular
sponding to the tobracket and tube theattachment
embrasure lineembrasure
position was
of eachdrawnline,from
tooth were
and forthemolars,
prox-a line
perpendicular the embrasure line was drawn from the proximal 1/3set
ofas
therepresenta-
line to the
imal 1/3 of the line tiveto the
buccal buccal
points
sidefor sidetooth
of each
each of each
tooth [3]. Atooth
(Figure line (Figure
2).connecting
On 2).
theaOn
this line, this
mesial and
clinical line, a point
distal
bracket clinical
contact
was bracket
points of each
set using the
point was set usingtooth the (embrasure
mandibular line) was
tooth drawn
thickness
mandibular tooth thickness data [12]. on the coordinates.
data [12]. For incisors, canines, and bicuspids,
a line perpendicular to the embrasure line was drawn from the middle of the embrasure
line, and for molars, a line perpendicular to the embrasure line was drawn from the prox-
imal 1/3 of the line to the buccal side of each tooth (Figure 2). On this line, a clinical bracket
point was set using the mandibular tooth thickness data [12].

(a) (b)
(a) (b)
Figure 1. How to set Figure
the coordinate
1. How toaxes set thein coordinate
the dentalaxes models.
in the (a) Themodels.
dental occlusal (a)planes of theplanes
The occlusal man-of the
dibular models wereFigure 1. How
photocopied
mandibular towith
modelsset were
thea coordinate
ruler axeswith
included
photocopied in for
the dental models.for
magnification
a ruler included (a)correction.
The occlusal(b)
magnification planes
Theofpho-
the(b)
correction. man-
The
dibular models were photocopied with a ruler included for magnification correction. (b) The pho-
tocopied images were placed in a digitizer, and most facial portions of 13 proximal contact areas
photocopied images were placed in a digitizer, and most facial portions of 13 proximal contact areas
tocopied images were placed in a digitizer, and most facial portions of 13 proximal contact areas
around the arch were around the arch
digitized and were digitized
setdigitized and set as theorigin
as the coordinate coordinate origin between
between the central incisors (point 7).
around the arch were and set as the coordinate originthe central
between the incisors (point
central incisors (point
Line
7). Line A: line connecting A: line
point connecting
3 and pointpoint
11;3 and
Line point
B: 11;
line Line B: line
connecting connecting
point 2 point
and 2 and
point point
12;
7). Line A: line connecting point 3 and point 11; Line B: line connecting point 2 and point 12; X-axis: 12;
X-axis: X-axis:
adjusted
adjusted to be parallel to be
to thetoaverage
adjusted parallel to
oftothe
be parallel the average
theslopes
averageof of the
ofLine slopes
A and
the slopes of Line A
LineAB;and
of Line and
Y-axis:Line B; Y-axis:
Line B;adjusted adjusted
to be to
to be per-
Y-axis: adjusted be
per-
perpendicular to the
pendicular to the X-axis. X-axis.
pendicular to the X-axis.

1
1

3
3
2

2
(a) (b)
Figure
Figure2.2.How
Howtotosetsetthe
theclinical bracket
clinical points
bracket pointsforfor
each tooth.
each tooth.(a) The clinical
(a) The bracket
clinical points
bracket of an-
points of
terior teeth.
anterior 1: The
teeth. clinical
1: The bracket
clinical points;
bracket 2: 2:
points; contact points;
contact points;3:3:perpendicular
perpendiculartotothe
themidpoint
midpointofofthe
the
(a)
line connecting the contact points. (b) The clinical bracket (b) points of premolars and molars. 1: The
line connecting the contact points. (b) The clinical bracket points of premolars and molars. 1: The
clinical bracket points; 2: contact points; 3: perpendicular to the mesial third of the line connecting
Figure 2. How to setthe thecontact
clinical
clinical bracketbracket
points; 2: points
contactfor
points (a:b = 1:3).
each3:tooth.
points; (a) Thetoclinical
perpendicular the mesialbracket
third ofpoints
the lineofconnecting
an-
the contact
terior teeth. 1: The clinical points
bracket (a:b = 1:3).
points; 2: contact points; 3: perpendicular to the midpoint of the
line connecting the contact points. (b) The clinical bracket points of premolars and molars. 1: The
clinical bracket points; 2: contact points; 3: perpendicular to the mesial third of the line connecting
the contact points (a:b = 1:3).
 All contact points were plotted by a single measurer. The measureme
assessed by statistically analyzing the differences between duplicate measur
Diagnostics 2023, 13, 3237 4 of 9
at least 2 weeks apart on 24 points selected at random. The measurement e
than 5% of the average value of the measurement and within acceptable lim
All contact points were plotted by a single measurer. The measurement error was
2.3. Measurement
assessed Items
by statistically (Figure
analyzing 3)
the differences between duplicate measurements taken
at least 2 weeks apart on 24 points selected at random. The measurement error was less
The measurement items included were as follows:
than 5% of the average value of the measurement and within acceptable limits.
1. Intercanine width, the distance between the canine clinical bracket poin
2.3. Measurement Items (Figure 3)
2. The Intermolar width, the distance between the first molar clinical bracket p
measurement items included were as follows:
3.1. Intercanine
Canine depth, thedistance
width, the shortest distance
between from
the canine a line
clinical connecting
bracket points; the canine cl
2. points towidth,
Intermolar the origin between
the distance betweenthethecentral incisors;
first molar clinical bracket points;
3. Canine depth, the shortest distance from
4. Molar depth, the shortest distance from a line a line connecting the canine clinical bracket
connecting the first m
points to the origin between the central incisors;
4. bracket
Molar points
depth, to the distance
the shortest origin between
from a linethe centralthe
connecting incisors;
first molar clinical
5. bracket
Caninepoints
W/D to ratio, thebetween
the origin ratio ofthethe
centralintercanine
incisors; width to the canine depth
6.5. Canine
MolarW/D W/Dratio, the ratio
ratio, of the intercanine
the ratio width to thewidth
of the intermolar canine todepth;
the molar depth.
6. Molar W/D ratio, the ratio of the intermolar width to the molar depth.
The Class IIIS group and control group were compared for the above it
The Class IIIS group and control group were compared for the above items.

Figure 3. Twelve clinical bracket points and four linear measurements of arch dimensions.
Figure 3. Twelve clinical bracket points and four linear measurements of arch dimen
1: intercanine width; 2: intermolar width; 3: canine depth; 4: molar depth.
canine width; 2: intermolar width; 3: canine depth; 4: molar depth.
To examine the effect of the degree of skeletal mandibular prognathism on the arch
form, the Class IIIS group was further subdivided into two subgroups—Wits appraisal
To examine the effect of the degree of skeletal mandibular prognathism
values of −10 mm or more and −10 mm or less—and the canine W/D ratios and molar
form, the were
W/D ratios Class IIIS group
compared betweenwas further
the two subdivided
subgroups. In addition,into twocomparison
a similar subgroups—W
values
betweenofthe−10
twomm or more
subgroups was and
made−10 mm classified
for those or less—and the canine
as a brachyfacial W/D
pattern ratios an
(low-
angle cases) and dolichofacial pattern (high-angle cases) to examine
ratios were compared between the two subgroups. In addition, a similar co the effect of facial
patterns on arch forms.
tween the two subgroups was made for those classified as a brachyfacial
2.4. Arch
angle form Comparison
cases) and dolichofacial pattern (high-angle cases) to examine the e
The
patterns coordinates
on3 arch of the twelve clinical bracket points were set, and the quartic equation
forms.
4 2
(y = ax + bx + cx + e) was fit using the least squares method. The average arch form with
clinical bracket points in the Class IIIS group and the average mandibular arch form in the
2.4. Arch
control form
group Comparison
were drawn on the same XY coordinates of reference and compared. Arch
forms were drawn for each facial pattern and compared with the control group.
The coordinates of the twelve clinical bracket points were set, and the
In addition, each dental arch form was selected from the square, ovoid, and tapered
tion
arch (y = ax
forms 4 + bx3 + cx2 + e) was fit using the least squares method. The avera
(OrthoForm, 3M Unitek, Monrovia, CA, USA) according to the criteria of
McLaughlin et al. [13].
with clinical bracket pointsThe arch form that Class
in the best matched that which
IIIS group andbest
thefitaverage
the 8 clinical
mandibu
bracket points from the first premolar to the first premolar was selected (Figure 4).
in the control group were drawn on the same XY coordinates of reference an
Arch forms were drawn for each facial pattern and compared with the contr
In addition, each dental arch form was selected from the square, ovoid
arch forms (OrthoForm, 3M Unitek, Monrovia, CA, USA) according to t
McLaughlin et al. [13]. The arch form that best matched that which best fit
bracket points from the first premolar to the first premolar was selected (Fig
 nostics 2023, 13, 3237
Diagnostics 2023, 13, 3237 5 of5 9of 10

(a) (b) (c)

Figure 4.Figure
Tapered, square,
4. Tapered, and and
square, ovoid arch
ovoid forms
arch formsused
usedfor
for classification (OrthoForm,
classification (OrthoForm, 3M 3M Unitek,
Unitek,
Monrovia, CA, USA):
Monrovia, (a) tapered;
CA, USA): (b) square;
(a) tapered; and
(b) square; (c)(c)ovoid.
and ovoid.

2.5. Statistical Analysis

2.5. Statistical Analysis
The sample size was calculated using the mean and standard deviation of the canine
The
W/Dsample
ratio size wasgroup
for each calculated using the mean
in our preliminary study,and
withstandard deviation
an alpha error of the
of 5% and canine
a beta
W/D ratio
errorfor
of each group
5%, and in ourwere
29 patients preliminary
required instudy, with an alpha error of 5% and a beta
each group.
error of 5%,Theandresult of the Shapiro–Wilk
29 patients were required test in
in this
eachstudy was p > 0.05, indicating normality.
group.
Anresult
The unresponsive Student’s t-test was
of the Shapiro–Wilk test used to compare
in this the p
study was two groups,
> 0.05, and a chi-square
indicating normality.
test was used to examine the arch forms’ frequency of occurrence. Significance was set at
An unresponsive Student’s t-test was used to compare the two groups, and a chi-square
p < 0.05. All statistical analyses were performed using Microsoft Office Excel (version 2306,
test wasMicrosoft,
used to Redmond,
examine the WA,arch
USA).forms’ frequency of occurrence. Significance was set at
p < 0.05. All statistical analyses were performed using Microsoft Office Excel (version 2306,
3. Results
Microsoft, Redmond, WA, USA).
Compared with the control group, the Class IIIS group showed no significant difference
in intercanine width, but the intermolar width, canine depth, and molar depth were
3. Results
significantly smaller, and the canine W/D ratio was significantly larger (Table 2).
Compared with the control group, the Class IIIS group showed no significant differ-
ence in Table
intercanine width,
2. Comparison but thebetween
of variables intermolar width,
Class IIIS groupcanine depth,
and control and molar depth were
group.
significantly smaller, and the canine W/D ratio was significantly larger (Table 2).
Groups Class IIIS Group Control Group
Measurement ItemsTable 2. Comparison
Average SD between Class
of variables Average SD group.
IIIS group and control p-Value
Intercanine width (mm) 29.17 1.87 29.89 1.52 NS
Groups
Intermolar widthClass
(mm) IIIS Group
48.69 3.11 Control50.70Group 2.81 0.001
Canine
Measurement Items depth (mm) Average 4.64 SD 1.14 Average5.66 1.01
SD 0.000
p−Value
Molar depth (mm) 24.91 2.15 26.28 1.94 0.000
ercanine width (mm)
Canine W/D ratio 29.17 6.73 1.87 1.94 29.89
5.43 1.52
0.87 0.000NS
Molar
ermolar width (mm) W/D ratio 48.69 1.97 3.11 0.21 1.94
50.70 0.15
2.81 NS0.001
NS: not significantly different.
Canine depth (mm) 4.64 1.14 5.66 1.01 0.000
Molar depth (mm) 24.91 2.15 26.28 1.94 0.000
Table 3 shows the canine W/D ratios, and the molar W/D ratios were not significantly
Canine W/D ratio 6.73 different between1.94 the Wits appraisal of5.43 0.87
−10 mm or more and 0.000
−10 mm or less subgroups.
Molar W/D ratio 1.97 0.21 1.94 0.15 NS
NS: not Table 3. Comparison
significantly of arch forms by Wits and facial pattern in Class IIIS group.
different.
Groups Wits ≤ −10 Wits > −10 Brachy Dolicho
Table 3 shows the canine W/D ratios, and the molar W/D ratios were not significantly
Measurement Items Average SD Average SD p-Value Average SD Average SD p-Value
different between the Wits appraisal of −10 mm or more and −10 mm or less subgroups.
Canine W/D ratio 7.71 3.77 6.47 2.22 NS 6.08 1.10 8.28 3.03 0.004
Molar W/D ratio In the facial
1.97 0.18 pattern comparison,
1.99 0.25 both NSthe canine
1.91 W/D0.16ratio2.07
and the0.22
molar 0.020
W/D ratio
were significantly smaller
NS: not significantly in the brachyfacial pattern.
different.
Comparing the Class IIIS and control groups’ arch form averages using the quartic
In the facial
equation showed thatpattern
the Class comparison, both had
IIIS group the canine W/Darch
a wider ratioanteriorly
and the molar W/D
and ratio
a narrower
were significantly smaller in the brachyfacial pattern.
arch posteriorly. A comparison of facial patterns showed that the brachyfacial pattern was
narrower anterior and posterior to the arch, whereas the dolichofacial pattern was wider
anterior to the arch and narrower posterior to the arch (Figure 5). The frequency of arch-
wire forms in each group is also shown. In the Class IIIS group, 42.5% were square, 31.9%
Diagnostics 2023, 13, 3237 6 of 10
Diagnostics 2023, 13, 3237 6 of 9

Table 3. Comparison of arch forms by Wits and facial pattern in Class IIIS group.
Comparing the Class IIIS and control groups’ arch form averages using the quartic
Groups Wits ≤ −10 Witsshowed
equation > −10 that the Class IIIS group Brachy Dolicho
had a wider arch anteriorly and a narrower
Measurement arch posteriorly. A comparison of facial patterns showed that the brachyfacial
Average SD Average SD p−Value Average SD Average SD pattern was
p−Value
Items narrower anterior and posterior to the arch, whereas the dolichofacial pattern was wider
Canine W/D anterior to the arch and narrower posterior to the arch (Figure 5). The frequency of archwire
7.71 3.77 6.47 2.22 NS 6.08 1.10 8.28 3.03 0.004
ratio forms in each group is also shown. In the Class IIIS group, 42.5% were square, 31.9% were
Molar W/D ovoid, and 25.6% were tapered; in the Class I group, 53.3% were square, 38.3% were ovoid,
1.97 0.18
and 8.3%1.99 0.25 The chi-square
were tapered. NS 1.91 0.16a statistically
test showed 2.07 significant
0.22 0.020
difference
ratio
between
NS: the two groups
not significantly (Table 4).
different.

(a) (b) (c)

Figure 5. Arch
Figure 5. Arch form comparison. Black:
form comparison. Black: control
control group;
group; orange:
orange: average
averageof
of Class
Class IIIS
IIIS group;
group; blue:
blue:
brachy in Class IIIS group; red: dolicho in Class IIIS group. (a) Comparison of averages of Class IIIS
brachy in Class IIIS group; red: dolicho in Class IIIS group. (a) Comparison of averages of Class
group and control group; (b) comparison of brachy in Class IIIS group and control group; (c) com-
IIIS group and control group; (b) comparison of brachy in Class IIIS group and control group;
parison of dolicho in Class IIIS group and control group.
(c) comparison of dolicho in Class IIIS group and control group.
Table 4. Comparison
Table 4. Comparison of frequency distributions
of frequency distributions of
of square,
square, ovoid,
ovoid, and
and tapered
tapered arch forms between
arch forms between
Class IIIS group and control group.
Class IIIS group and control group.
Groups Square Ovoid Tapered p−Value
Groups Square Ovoid Tapered p-Value
Class IIIS group 20 (42.5%) 15 (31.9%) 12 (25.6%)
Class IIIS group 20 (42.5%) 15 (31.9%) 12 (25.6%) 0.016
Control group 32Control
(53.3%) group
23 (38.3%)
32 (53.3%) 23 (38.3%)
5 (8.3%) 5 (8.3%) 0.016

4. Discussion
4. Discussion
Based on research on relapse, Little recommended that pre-treatment dental arch
Based on research on relapse, Little recommended that pre-treatment dental arch
morphology should be used as an important indicator for post-treatment dental arch mor-
morphology should be used as an important indicator for post-treatment dental arch
phology [14]. Many studies have shown that maintaining the pre-treatment intercanine
morphology [14]. Many studies have shown that maintaining the pre-treatment intercanine
width and arch morphology of the mandibular dentition after treatment is beneficial for
width and arch morphology of the mandibular dentition after treatment is beneficial for
long-term occlusal stability [15,16].
long-term occlusal stability [15,16].
However, with the recent development of elastic-rich wire materials and the pre-ad-
However, with the recent development of elastic-rich wire materials and the pre-
justed appliance system, various companies have introduced ready-made archwire forms
adjusted appliance system, various companies have introduced ready-made archwire
based on the average arch form obtained from normal occlusion. Therefore, those wire
forms based on the average arch form obtained from normal occlusion. Therefore, those
materials have have
wire materials been been
increasingly usedused
increasingly in full-scale orthodontic
in full-scale orthodontic treatment,
treatment,mainly in the
mainly in
leveling
the leveling and alignment treatment stage. Because of its characteristics, it is difficult cli-
and alignment treatment stage. Because of its characteristics, it is difficult for for
nicians to to
clinicians adjust
adjustthe arch
the archform
formfor
foreach
eachpatient.
patient.Therefore,
Therefore,ininmany manycases,
cases,itit is
is considered
considered
appropriate
appropriate to select from several ready-made archwire forms that approximatethe
to select from several ready-made archwire forms that approximate the pre-
pre-
treatment
treatment arch form, taking into account race and the type of malocclusion, and to make
arch form, taking into account race and the type of malocclusion, and to make
fine
fine adjustments
adjustments for for each
each patient.
patient.
In
In research on arch forms
research on arch forms in
in Japanese
Japanese people,
people, Sebata
Sebata et et al.
al. [17]
[17] and
and Kosaka
Kosaka et et al.
al. [18]
[18]
reported on Class I malocclusions, and Kayukawa et al. [8] and Imaizumi
reported on Class I malocclusions, and Kayukawa et al. [8] and Imaizumi et al. [9] reported et al. [9] reported
on
on patients with Class
patients with ClassIIIIIImalocclusions.
malocclusions.TheyTheystated
statedthatthatthere
thereisisnono significant
significant difference
difference in
in arch
arch width
width between
between thosethose
withwith
ClassClass III malocclusions
III malocclusions and with
and those thoseClass
withI Class I maloc-
malocclusions,
clusions, but length
but the arch the archislength is significantly
significantly greater. greater.
However, However,
there arethere are no reports
no reports of archofforms
arch
limited to patients with skeletal mandibular prognathism diagnosed as requiring surgical
Diagnostics 2023, 13, 3237 7 of 9

orthodontic treatment. As surgical orthodontic treatment is a major part of orthodontic

treatment [19], it is important to compare and contrast them.
For the measurement method in the present study, we referred to the method of
Nojima et al. [3], who compared the arch forms of Caucasian and Japanese people using an
arch form with a series of clinical bracket points, rather than an arch form with a cusp and
incisor series, to obtain guidelines that can be clinically applied.
The results of the present study showed that mandibular prognathism was not signif-
icantly different from Class I malocclusion in terms of intercanine width, and it showed
significantly smaller values in intermolar width, canine depth, and molar depth. There-
fore, the canine W/D ratio was significantly greater, and the molar W/D ratio was not
significantly different.
Nojima et al. [3] and Braun et al. [20] stated that the intercanine and intermolar widths
were significantly greater in Class III malocclusions than in Class I malocclusions. In
terms of arch length, Kayukawa et al. [8] stated that both canine and molar depths were
significantly larger. Thus, it can be inferred that skeletal factors affected the results that
differed from those of the present study. In other words, since the anteroposterior occlusal
relationship in skeletal mandibular prognathism presents a significant Class III molar
relationship, many of the mandibular first molars are in occlusion with the maxillary
premolars, which are in occlusion with a more constricted area, resulting in lingual tipping
of the mandibular molars and a smaller intermolar width. In addition, the arch length is
small due to dental compensation in the mandibular anterior.
When comparing arch forms, skeletal mandibular prognathism showed flatter curves
in the anterior arch and narrower molars compared with Class I malocclusion. In the
present study, we assumed that the more pronounced skeletal Class III is, the stronger this
tendency becomes, and we used Wits appraisal for comparison. ANB and Wits appraisal
are the principal cephalometric parameters that indicate the anteroposterior position of
the skeleton. However, in skeletal mandibular prognathism, the Wits appraisal, which
was used in the present study, is considered to be more indicative of anteroposterior devi-
ation [21]. However, this comparison showed no significant differences, suggesting that
anteroposterior deviation was not the only effect. In addition, a comparison of the vertical
position of the skeleton in terms of the facial pattern showed significant differences, indicat-
ing that the arch form differs depending on the vertical factor. In the brachyfacial pattern
(low-angle cases), there was little anterior curve flattening, whereas in the dolichofacial
(high-angle cases) pattern, anterior curve flattening, a characteristic of skeletal Class III, was
high. This may be because of the longer mandibular length in high-angle cases, resulting in
higher dental compensation in the anterior. Since this vertical deviation is not manifested
numerically as an anteroposterior deviation of the skeleton, it is thought to have had little
effect on the Wits appraisal.
Engel [22] classified archwire forms into nine categories, and Raberin et al. [23] classi-
fied them into five categories, trying to accommodate clinically various arch forms. More-
over, Nojima et al. [3] classified mandibular arch forms into square, ovoid, and tapered
according to McLaughlin et al.’s criteria [13] and characterized their arch forms based on
their frequency of occurrence, such that no statistically significant differences were found
between races in each arch form. Therefore, this classification into three categories was
considered appropriate in orthodontic practice, and this classification method was also
used in this study.
The frequency of occurrence of ready-made archwire forms in this study was almost
half for the square form in the Class IIIS group, with the ovoid and tapered forms each
accounting for half of that number. In the Class I group, square accounted for more than
half, ovoid for approximately one-third, and tapered for a small number, indicating that
the frequency of occurrence differed between the two groups. Namely, the frequency of
occurrence of the square form was similar, but the Class III S group had an increased rate
of the tapered form compared with the Class I group. This is because the Class III S group
in this study consisted of 24 brachy, 13 mesio, and 10 dolicho cases, with a large proportion
Diagnostics 2023, 13, 3237 8 of 9

of brachy cases, which may have increased the number of tapered cases. The results of this
study indicate that the arch form of skeletal mandibular prognathism is often square and
that vertical skeletal relationships, such as facial patterns, may also have a significant effect
on the arch form.
According to the results of this study, skeletal mandibular prognathism showed lingual
tipping of the mandibular anterior due to dental compensation and palatal tipping of the
molars also due to dental compensation [24]. Compared with Class I malocclusion, there
was a difference in flattened curves in the anterior and a narrowed arch form in the molars.
In presurgical orthodontics, it is considered important to release these dental compensations
and to set appropriate tooth axes and arch forms about the jawbone. Therefore, it is thought
that a specific archwire form should not be applied to all mandibular prognathism patients.
However, no difference was observed in the intercanine width compared with Class I
malocclusion, suggesting that the preoperative intercanine width should be used as a
reference for arch form selection.
Little et al. [14] focused on the mandibular arch form from the perspective of relapse,
so the maxillary arch form was not investigated. However, the maxillary arch form of
patients with mandibular prognathism may also be affected and should be investigated in
the future as well [25].
In addition, patients with skeletal mandibular prognathism often have facial asym-
metry, which may affect the arch form. Therefore, patients with facial asymmetry were
excluded from this study.
Facial and intraoral 3D scanning has become widely used in recent years [26], and ap-
plying these techniques for facial soft tissue analysis and tooth axis analysis will contribute
to more refined surgical orthodontic treatment in the future.

5. Conclusions
In this study, the mandibular arch form of skeletal mandibular prognathism for which
surgical orthodontics was indicated was compared with that of Class I malocclusion, and
its characteristics were clarified.
First, compared with Class I malocclusion, the mandibular arch form of skeletal
mandibular prognathism showed no significant difference in intercanine width; a signifi-
cantly smaller intermolar width, canine depth, and molar depth; and a significantly larger
intercanine W/D ratio.
Second, arch forms drawn using a quartic equation demonstrated that skeletal mandibu-
lar prognathism showed flatter curves in the anterior and narrower widths in the mo-
lars compared with Class I malocclusion. This is presumably because the anterior and
molars show dental compensation due to the incongruity of the position of the maxilla
and mandible.
Finally, a comparison of arch forms by facial pattern showed that the anterior of the
dolichofacial pattern (high-angle cases) was nearly flat, indicating higher dental compensa-
tion in the anterior.

Author Contributions: Conceptualization, E.I., C.T., K.N., S.M., K.S., A.W., N.K. and Y.N.; methodol-
ogy, E.I., C.T., K.N., S.M., K.S., A.W., N.K. and Y.N.; validation, E.I. and C.T.; formal analysis, E.I., C.T.,
K.N. and Y.N.; investigation, E.I. and C.T.; resources, E.I., C.T., K.N., S.M., K.S., A.W., N.K. and Y.N.;
data curation, E.I. and C.T.; writing—original draft preparation, E.I.; writing—review and editing,
E.I., C.T., S.M., K.S., A.W. and N.K.; visualization, E.I., C.T., K.N. and S.M.; supervision, Y.N.; project
administration, E.I., C.T., K.N., S.M., K.S., A.W., N.K. and Y.N. All authors have read and agreed to
the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: The study protocol was approved by the Tokyo Dental
College Ethics Committee (approval no. 1018).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Diagnostics 2023, 13, 3237 9 of 9

Data Availability Statement: The data presented in this study are available upon request from the
corresponding author.
Conflicts of Interest: The authors declare no conflict of interest.

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