SPACE

ANALYSIS

1
Presented by:
Dr. Gunjan Bhansali
 CONTENTS
 Introduction
 Mixed dentition space analysis:

1. Nance – Carey’s analysis

2. Tweed’s analysis

3. Total space analysis

4. Moyer’s mixed dentition space analysis

5. Tanaka Johnston’s analysis

6. Huckaba’s method of prediction

2
7. Hixon & Oldfather’s method
 Permanent dentition space analysis:

1. Carey’s analysis

2. Royal London space planning

3. Ashley Howe’s analysis

4. Pont’s index

5. Linder Harth index

6. Korkhaus analysis

7. Bolton’s analysis
 Conclusion
3
 INTRODUCTION
 Space analysis is one of the essential diagnostic aids.

 It helps to visualize patient’s occlusion from all aspects &

also make necessary measurements of teeth, dental arches
& basal bones.

 Space analysis requires a comparison between the amount

of space available for the alignment of the teeth & the
4

amount of space required to align them properly.

 INTRODUCTION

 Proper alignment of the teeth requires harmony between

the teeth sizes and the space available within the dental
arch.

 Sometimes the space available is not similar to the space

required for the alignment of the teeth.

5
 INTRODUCTION

 It is thus important for the clinician to determine prior to

the onset of the orthodontic treatment the space
requirements necessary for favorable results.

 To accomplish this, a space analysis must be done.

6
 MIXED DENTITION SPACE
ANALYSIS
 A Mixed Dentition Space Analysis helps one to estimate
the amount of spacing or crowding which would exist for
the patient if all the primary teeth were replaced by their
successors the very day the analysis is done.

7
 Many mixed dentition space analysis have been suggested, all
falling into 3 categories:

1. Radiographic methods: Those in which the sizes of unerupted

cuspids and bicuspids are estimated from measurements of
their radiographic images.

2. Dental measurement methods: Those in which the sizes of the

cuspids and bicuspids are derived from knowledge of the
sizes of permanent teeth already erupted in the mouth.

8
3. A combination of above approaches.
NANCE – CAREY’S ANALYSIS
 In evaluating the available bone structure to accommodate
the permanent dentition, it is necessary to make certain
calculations in the mixed dentition.

 In the extensive work done by Nance & Carey,

measurements taken from dental casts were compiled to
set down a working basis for determining when and when
not to reduce tooth structure as a treatment procedure.
9
 The decision to extract must be preceded by a great deal
of thought and study.

 What is the approximate amount of basal bone

deficiency?

 This can be closely determined by a method of

measuring the linear dimension over the buccal cusps
and over the anterior ridge and comparing this with the
10
sum of the mesiodistal diameters of the teeth.
 METHOD
 An 0.012 brass wire is adapted
to the lower mixed dentition
model so that one end engages
the mesiobuccal line angle of
the lower left first permanent
molar near the marginal ridge.

11
 The wire then passes over the buccal cusps of the
deciduous molars, through their greatest diameters, over
the normal cuspal position of the cuspids, then over the
anterior teeth at ridge center where the incisal edges of
the lower anterior teeth are normally found, then around
the same course on the opposite side, ending in the
mesiobuccal line angle of the lower right first permanent
molar.

12
 The wire is cut at this point, measured and recorded.
 Then the mesiodistal diameters of lower anterior teeth
are measured and their sum taken.

 From measurements made on the casts of a hundred

cases of primary and secondary dentitions of the same
patient, Carey found that a definite relationship exists
between the sizes of these teeth and the unerupted
cuspids and two premolars, and have deviced a table for
quickly making this determination without the aid of x-
rays. 13
14
 A clinical calculator had also been devised to enable the
operator to have an instrument readily accessible for
making this determination.

15
 Carey’s formula for calculating width of cuspids &
bicuspids is as follows:

LA + 2(X) + 3.4 = L.D

 L.A  Sum of Lower Anterior Teeth

 (X)  Estimated size of the two premolars and cuspid
 3.4  Inevitable mesial drift (1.7 mm) of the first
permanent molar on each side following exfoliation of
the deciduous molars.
16
 L.D  Linear dimension (Length of the wire)
 If it is smaller by 2.5 mm or less, a lingual arch treatment
is justified before loss of the deciduous molars in order
to accomplish a satisfactory result in treatment without
extraction of premolars.

 If it is more than 2.5mm, reduction in tooth material was

suggested by Nance & Carey depending upon the
patient’s profile and clinical evaluation.
17
 This analysis can be applied to the permanent dentition as
well.

 3.4 mm figure is not included in the formula and measures

the actual diameter of the cuspids and premolars or just
refer to the table for the (X) value.

 The variation in linear dimension in the permanent

dentition when extraction is indicated will vary from

-2.5 to -14. 18
 SIGNIFICANCE
 It is possible to diagnose cases reporting in the mixed dentition
with fair degree of accuracy regarding possibilities of treatment
with or without extraction of premolars in the permanent
dentition.

 Calculations may be made from tooth and linear arch

measurements to determine whether any retentive type of
treatment in the mixed dentition will be successful in obtaining a
slight increase in linear dimension of the permanent dentition
and thus obviate reduction of tooth structure in borderline cases. 19
 TWEED’S METHOD

 The space required for the four mandibular incisors were

measured at their greatest mesiodistal crown diameter by
means of a sliding Boley gauge, with pointed beaks.

 The values for unerupted canines and premolars were

obtained by measuring their greatest mesiodistal crown
diameter of their images on the periapical radiograph.
20
21
 To reduces radiographic enlargement, the formula
recommended by Huckaba was used in all radiographic
measurement :

X = (Y) (X’)
Y’

 X  Estimated size of the permanent tooth

 X’  Radiographic size of the permanent teeth
 Y  The size of the primary mandibular second molar
on the cast.
22
 Y’  the radiographic size of the primary molar.
 The values obtained for the mandibular incisors on the
cast and those for the canines and premolars on the
radiograph were added to provide the space required.

 The space available was obtained by extending a brass

wire from the mesiobuccal cusp of the first permanent
molar on one side to the mesiobuccal of the molar on the
opposite side, passing through the buccal cusps and
incisal edges of the remaining teeth.
23
 The difference in the values obtained for the space
required and space available was the amount of the
discrepancy.

 An assessment of the relations between the axial

inclination of the mandibular incisors and the basal bone
was made on a tracing of the lateral cephalogram.

24
The amount of alveo-dental protrusion or retrusion was 25

assessed and incorporated into the mixed dentition analysis.

 Tweed Head plate correction guidelines are:

26
 If for a specific FMA (30) the FMIA (49) did not
correspond, an objective line was traced to form the
required FMIA (65).

 Then the distance between this objective line and the line
that passed through the actual inclination of the
mandibular incisors was measured on the occlusal plane
with pointed calipers to the nearest 0.1 mm (6 mm).

27
 This figure was multiplied by ‘2’ to include right and left
sides (12 mm).

 The total was the cephalometric correction which was

then added to the difference between the space required
and space available to yield total discrepancy.

28
 TOTAL SPACE ANALYSIS IN MIXED
DENTITION

 Given by Leven Merrifield in 1988.

 The various mixed dentition analysis demonstrate the

discrepancy only and do not indicate the exact area where
the discrepancy occurs.

 In many instances, the problem is confined to one area, it

is desirable to know the area affected. The total space 29

analysis provides this precise information.

 This method divides the lower dental arch into three
areas – ANTERIOR, MIDARCH AND POSTERIOR –
to analyse the space requirement in the lower arch.

 Measurements from the study casts and cephalograms

are used in this analysis. The discrepancies for each area
has to be calculated and the resultant values are added
together to yield the discrepancy of the arch.

30
 ANTERIOR AREA

 Anterior space analysis includes the measurement in

millimeters of the space available in the mandibular arch
from canine to canine and a measurement of the
mesiodistal dimension of each of the six anterior teeth.

 The difference is referred to as a surplus or deficit.

31
 Tweed’s cephalometric discrepancy is used to further
analyze this area.

 The cephalometric discrepancy is defined as the amount

of space required to upright the mandibular incisors for
optimum facial balance.

 This value is added to the anterior space measurement.

32
 The sum of the anterior tooth arch surplus or deficit and
the cephalometric discrepancy is referred to as the
anterior discrepancy.

 Each of the values in the anterior discrepancy calculation

has been given a difficulty factor so that an anterior
space analysis difficulty value can be calculated.

33
 MIDARCH AREA
 The mid-arch area includes the mandibular first molars
and the first and second premolars.

 Space available: Careful measurement of the space from

the distal of the canine to the distal of the first molar
should be recorded as available midarch space.

34
 Space required: An equally accurate measurement of the
mesiodistal width of the first premolar, the second
premolar (from the radiograph), and the first molar must
also be recorded.

 To this value is added the space required to level the

Curve of Spee.

35
 The following formula was applied to know the space
required for leveling the curve of spee.

Depth on right side + Depth of left side + 0.5mm

2

 From these measurements, the orthodontist can

determine the space deficit or surplus in the mid-arch
area.
36
 Also, if there is any occlusal disharmony like Class II or
Class III malocclusion, the difficulty score is given
according to this.

 The score for occlusal disharmony is 2.

37
 POSTERIOR AREA

 Space Required:
 Mesiodistal width of second and third molars is obtained
from the radiographs as they might be unerupted.

 If these molars are not visible on the radiographs,

‘Wheelers’ method is used for calculation.

38
 X = Y – X’
Y’

 X  Estimated value of third molars in the individual

patient.

 Y  Actual size of permanent mandibular first molar.

 X’  Wheelers value of third molars.

39

 Y’  Wheelers value of first molars.

 Space Available:
 The amount of space available consisted of space
presently available from distal of first molars to anterior
border of ramus and the estimated increase.

 Space presently available: The measurement is made

from the distal of the mandibular first molar to the
anterior border of the ramus along the occlusal plane.

40
2. Estimated increase or prediction : The estimated
increase is 3 mm / year i.e. 1.5 mm on either side until
14 years of age in girls and 16 years in boys.

 Both these values are added to get posterior surplus or

deficit.

 The posterior space analysis surplus or deficit has been

given a low difficulty factor of 0.5 because a posterior
space deficit can be easily resolved with third molar 41

removal.
 TOTAL SPACE DEFICIT

 The total discrepancy is arrived at by comparing the

space required and space available in the anterior, mid-
arch and posterior areas.

 Thus this analysis tells us precisely where the

discrepancy is present, i.e. in the anterior, mid-arch or
the posterior areas.
42
43
MOYER’S MIXED DENTITION ANALYSIS

 Given by Moyers in 1967.

 In this analysis size of the cuspids and premolars are

derived from the knowledge of the size of permanent
teeth already erupted in the mouth.

 The lower incisors are measured to predict the size of

upper as well as lower posterior teeth. 44
 METHOD
1. Measure with the Boley gauge, the greatest mesiodistal
width of each of the four mandibular incisors. Record
these values on the Mixed Dentition Analysis form.

2. Determine the amount of space needed for alignment of

the incisors. Set the Boley gauge to a value equal to the
sum of the widths of the left central incisor and left
lateral incisor.
45
46
 Place one point of the gauge at the midline of the
alveolar crest between the central incisors and let the
other point lie along the line of the dental arch on the left
side.

 Mark on the tooth or the cast the precise point where the
distal surface of the lateral incisor will be when it has
been aligned. Repeat this process for the right side of the
arch.
47
3. Compute the amount of space
available after incisor alignment
by measuring the distance from
the point marked in the line of the
arch i.e. from the distal surface of
the lateral incisor in a well formed
anterior arch form to the mesial
surface of the first permanent
molar. This distance is the space
available for the permanent
48
cuspids and bicuspids.
4. Predict the size of the combined widths of the
mandibular cuspids and bicuspids using the probability
charts.

 Moyer uses 75% of probability rather than 50%.

Although the values distribute normally towards
spacing and crowding. Crowding is a much more
serious clinical problem and the 75% predictive values
thus protects the clinician of the safe side.
49
TABLE

50
51
5. Compute the amount of space left in the arch for molar
adjustment by subtracting the estimated cuspid and
bicuspid size from the measured space available in the
arch after alignment of the incisors.

6. Record these values for each side.

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MIXED DENTITION ANALYSIS
FORM

53
 MERITS
 It has minimal systematic error and the range of such
error is known.

 Although best done on dental casts, it can be done

with reasonable accuracy in the mouth.

 It can be used for both dental arches.

54
 DEMERIT

 Moyer’s Mixed Dentition Analysis over predicts the

tooth size of the unerupted canines and premolars, hence
it may convert a borderline case into an extraction case.

55
 TANAKA AND JOHNSTON
METHOD
 Given by Marvin M. Tanaka & Lysle E. Johnston in 1974.

 Tanaka and Johnston developed another way to use the

width of the lower incisors to predict the sizes of the
unerupted canines and premolars.

 This method has good accuracy despite a small bias

toward overestimating the size of unerupted tooth.
56
 TANAKA AND JOHNSTON
PREDICTION VALUES

One half the mesiodistal width of four lower incisors +

10.5 = Estimated width of mandibular canine and
premolar in one quadrant.

One half the mesiodistal width of four lower incisors +

11.0 = Estimated width of maxillary canine and
premolars in one quadrant.
57
 HUCKABA’S METHOD OF
PREDICTION
 Given by George W. Huckaba in 1964. It based on the
measurement of teeth on radiograph.

 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 cast, using a primary
58
molar tooth.
 The formula is as follows:

X = (Y) (X’)
Y’

 X  Estimated size of the permanent tooth

 X’  Radiographic size of the permanent teeth
 Y  The size of the primary mandibular second molar
on the cast.
 Y’  the radiographic size of the primary molar.

59
 Accuracy is fair to good depending on the quality of
radiographs and their positions in the arch. The
technique can be used in maxillary and mandibular
arches for all ethnic group.

60
 HIXON AND OLDFATHER
PREDICTION
 Given in 1957. This method of prediction uses both the
radiographs and prediction tables.

 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 casts and the size of unerupted premolars
measured from the periapical films to predict the size of
61
unerupted canines.
 Mandibular dental casts of 41 subject from Iowa facial
growth study, 7 ½ to 11 years of age were measured. X-
ray films of unerupted premolars were taken

 The best estimate was obtained when mesiodistal width

of left central and lateral incisors were combined with X-
ray measurement of unerupted first and second
premolars of the same side.

62
 From the prediction table, the predicted size of the
unerupted canines and premolars are found against the
measured value. This method is restricted to the
mandible only.
Measured value Estimated tooth size
23 18.4
24 19.0
25 19.7
26 20.3
27 21.0
28 21.6
29 22.3
63
30 22.9
REVISED HIXON AND OLDFATHER
METHOD

 Given by Staley & Kerber in 1980.

 Staley and Kerber developed a graph from IOWA growth

data which allows canine width to be read directly from
the sum of incisor and premolars width.

 This method can be used only for the mandibular arch.

64
 Measurements were taken to the nearest 0.05 mm with
Helios dial caliper.

 All computations were performed by a computer.

65
66
 MOYER’S PROBABILITY TABLE
ACCORDING TO CONTEMPORARY
INDIAN POPULATION

67
Philip NI et al. Applicability of the Moyers mixed dentition probability tables and new 68
prediction aids for a contemporary population in India. Am J Orthod Dentofacial Orthop
2010;138:339-45.
MOYER’S PROBABILITY TABLE ACCORDING TO
CENTRAL INDIAN POPULATION

69
Nayak A, Hazarey P. Evaluation of Applicability of Moyers' 70
Mixed Dentition Analysis For Central India Population. J Ind Orthod Soc 2004; 37:154-159 .
 TANAKA-JOHNSTON VALUES MODIFIED
ACCORDING TO NORTH INDIA POPULATION

 For males:

1. Maxillary arch:

Y = 2.9 + 0.40(X)

2. Mandibular arch:

Y = 3.91 + 0.37(X)
71
 TANAKA-JOHNSTON VALUES MODIFIED
ACCORDING TO NORTH INDIA POPULATION

 For females:

1. Maxillary arch:

Y = 0.56 + 0.45(X)

2. Mandibular arch:

Y = 1.14 + 0.42(X)
72
Goyal RK et al. Evaluation of mixed dentition analyses in north Indian population: A
comparative study. Contemp Clin Dent. 2014;5(4):471-7.
 SPACE ANALYSIS IN
PERMANENT DENTITION

73
 CAREY’S ANALYSIS
 This analysis helps to determine the extent of the
discrepancy.

 It is performed on the lower cast.

 Same analysis on the upper cast is called Arch Perimeter

Analysis.

74
 DETERMINATION OF TOOTH MATERIAL

 The mesio-distal width of the teeth anterior to the first

molars (second premolar to second premolar) is
measured and summed up.

75
DETERMINATION OF ARCH LENGTH

 The arch length anterior to the first permanent molar is

measured using a soft brass wire.

 The wire is placed contacting the mesial surface of the

first permanent molar of one side and is paced over the
buccal cusps of the premolars and along the anteriors
and is continued on the opposite side upto the mesial
surface of the opposite first permanent molar.
76
 In case of proclined anteriors, the wire is passed along
the cingulum of the anterior teeth.

 If the anterior teeth are retroclined, the brass wire in the

anterior segment passes labial to the teeth.

 If the anterior teeth are well aligned the wire passes over
the incisal edge of anteriors.

77
DETERMINATION OF ARCH LENGTH

78
 DETERMINATION OF THE DISCREPANCY

 The discrepancy refers to the difference between the arch

length and tooth material.

1. If the discrepancy is 0-2.5 mm, it indicates minimal

tooth material excess. Proximal stripping can be
carried out to reduce the tooth material.

2. If the discrepancy is between 2.5-5mm, it indicates the

need to extract the second premolars.

3. A discrepancy of more than 5mm indicates the need to

79
extract the first premolars.
80
 THE ROYAL LONDON SPACE PLANNING

 The Royal London Space Planning has evolved since

1985 as the part of the postgraduate training program at
the Royal London Hospital.

 The theoretical basis is derived from the work of

Andrews, who states that a space discrepancy will arise
if the teeth do not conform to his “six keys to normal
occlusion”.
81
 The purpose of the Royal London Space Planning is to
quantify the space required in each dental arch to attain
the treatment objectives in the permanent or late mixed
dentition.

 Six specific aspects of the occlusion are considered for

which any change has an effect on the space required.

82
 SPACE REQUIREMENTS
1. Crowding and spacing: Measure in relation to the line
of arch that reflects the majority of teeth.

83
2. Leveling curve of spee: Assess the depth of curve from
premolar cusps to a flat plane on distal cusps of first molar
and incisors. Only one value is given for the arch, and only if
the premolars have not been assessed separately as crowded.
Allow 1 mm space for 3 mm depth of curve, 1.5 mm for 4
mm depth, and 2 mm space for a 5 mm curve.

84
3. Arch width change: Allow 0.5mm space for each mm
posterior arch width change.

4. Incisor A/P change: For the purpose of space planning,

each millimeter of incisor advancement or retraction
will create or consume 2 mm of space within the dental
arch.

85
5. Angulation change: Applies only to maxillary incisors.
Allow 0.5 mm space for correction of each parallel
sided vertical tooth (usually no allowance is necessary).

86
6. Inclination change: Applies only to maxillary incisors.
Allow 1 mm space for every 5° change affecting all 4
incisors, and 0.5 mm space if only 2 teeth are affected.

 As the space implications are relatively small, the

angulation and inclination scores are combined on the
space planning form.

87
 SPACE CREATION
1. Tooth reduction: Record the total mesiodistal enamel
reduction for each arch. This may be to reshape an
individual tooth or to relieve small amounts of
crowding.

2. Tooth enlargement: Record the space to be used by

building up teeth pre-treatment, or to be created if the
build up is to be undertaken post-treatment.
88
3. Extractions: Record the mesiodistal width of the
permanent teeth to be extracted (excluding second and
third molars). The extraction of primary teeth is not
recorded except if the permanent successors are absent.

4. Space opening: Record any space to be created or kept

in the arches for prostheses.

89
5. Molar distal change: Estimate the amount of distal
movement required from molars during treatment. This
frequently has to be adjusted in order to achieve a zero
residue at the end of space planning. It is then
necessary to assess whether the anticipated molar
movements are realistic.

6. Molar mesial change: Estimate the anticipated forward

migration of molars, either due to active appliance
90
treatment or anchorage loss.
7. Differential growth: Estimate the A/P growth
differences between the maxilla and mandible during
treatment (not necessary for most patients). A positive
upper space assessment applies to forward growing
Class II cases, but a negative lower assessment applies
for the creation of additional space in Class III cases
where a deterioration in arch relationship is anticipated
during and after treatment.

91
 The residue should be zero in both arches. It may be
necessary to adjust the treatment objectives to achieve
this, but these must remain attainable and not simply
manipulated in order to achieve the zero residue.

92
93
ASHLEY HOWE’S ANALYSIS

 Ashley Howe considered tooth crowding to be due to

deficiency in arch width rather than arch length.

 He found the relationship between the total width of the

12 teeth anterior to the second molars and the width of
the dental arch in the first premolar region.

94
 DETERMINATION OF TOTAL TOOTH MATERIAL

 The mesio-distal width of all teeth mesial to the second

permanent molars is measured and summed up.
 This value is called the Total Tooth Material (TTM).

95
DETERMINATION OF PREMOLAR DIAMETER

 The Premolar Diameter (PMD) refers to the width from

the tip of the buccal cusp of one first premolar to the tip
of buccal cusp of the opposite first premolar.

96
DETERMINATION OF PREMOLAR
BASAL ARCH WIDTH

 The measurement of the width from canine fossa of one

side to the other gives us the Premolar Basal Arch Width
(PMBAW).

 If the canine fossa is not clearly distinguishable, the

measurement is made from a point that is 8 mm below
the crest of the inter-dental papilla distal to the canine.
97
DETERMINATION OF PREMOLAR
BASAL ARCH WIDTH

98
 According to Ashley Howe, to achieve normal occlusion
with a full complement of teeth, the PMBAW should be
44% of the TTM.

 This ratio is called the PMBAW%. Formula is as

follows:

PMBAW% = PMBAW x 100

TTM

99
INFERENCE

100
101
 ANALYSIS IN SOUTH INDIAN
POPULATION

 It showed that the mean PMBAW% to the TTM was

around 45.848 with a standard deviation of 2.238.

 The study concluded that Ashley Howe’s analysis is not

reliable in South Indian population. Ethnic variations are

seen between the original study and the present study.

Govindaraj A et al. Reliability of Ashley Howe's analysis in South Indian population. Drug 102
Intervention Today. 2019;11(2):413-20.
 PONTS ANALYSIS
 Ponts in 1909 presented a system whereby the
measurement of the four maxillary incisors automatically
establish the width of the arch in the premolar and molar
regions.

 He suggested that the ratio of the combined upper incisor

width to transverse arch width was ideally 0.80 in the
premolar area and 0.64 in the molar area.
103
 PONTS ANALYSIS HELPS IN:

1. Determining whether the dental arch is narrow or is

normal in the premolar and molar regions.

2. Determining the need for lateral arch expansion.

3. Determining how much expansion is possible at the

premolar and molar regions.

104
 INCISORS

 The mesio-distal width of 4 maxillary incisors is

measured and summed up (SI).

105
DETERMINATION OF MEASURED
PREMOLAR VALUE
 Width of the arch in the premolar region from the distal
pit of one upper first premolar to the distal pit of
opposite first premolar is measures (MPV).

106
DETERMINATION OF MEASURED
MOLAR VALUE
 Width of the arch in molar region from the mesial pit of
one upper first molar to the mesial pit of the opposite
first molar is measured (MMV).

107
 DETERMINATION OF
CALCULATED PREMOLAR VALUE

 Calculated premolar value (CPV) or the expected arch

width in the premolar region is determined by the
formula:

CPV = SI x 100
80

108
 DETERMINATION OF
CALCULATED MOLAR VALUE

 Calculated molar value (CMV) or the expected arch

width in the molar region is determined by the formula:

CMV = SI x 100
64

109
INFERENCE

110
 LINDER HARTH INDEX
 This analysis is very similar to Ponts analysis except that
a new formula has been proposed to determine the CPV
& CMV.

CPV = SI x 100
85

CMV = SI x 100
64

111
 CHADDA’S INDEX
 Chadda modified the Pont’s formula for CPV and CMV
according to Indian population and suggested the
following formula:

CPV = SI x 100
83.7

CMV = SI x 100
63.7
112
 KORKHAUS ANALYSIS
 Similar to Ponts & Linder Harth analysis.

 Makes use of Linder Harth’s formula to determine the

ideal arch width in the premolar and molar regions.

 In addition, this analysis utilizes a measurement made

from the mid-point of the inter-premolar line to a point
in between the two maxillary incisors. 113
 According to Korkhaus, for a given
width of upper incisor a specific value
of the distance between the mid-point
of inter-premolar line to the point
between the two maxillary incisors
should exist.

 An increase in this measurement

denotes proclined upper anteriors
while a decrease denotes retroclined
114
upper anteriors.
 BOLTON’S ANALYSIS
 According to Bolton, there exists a ratio between the
mesio-distal widths of maxillary and mandibular teeth.

 Many malocclusions occur as a result of abnormalities in

tooth size.

 The Bolton’s analysis helps in determining disproportion

in size between maxillary and mandibular teeth.
115
 MEASUREMENTS
1. Sum of maxillary 12: Mesio-distal
widths of all teeth mesial to
maxillary second molars are
measured and summed up.

2. Sum of mandibular 12: Mesio-distal

widths of all teeth mesial to
mandibular second molars are
116
measured and summed up.
3. Sum of maxillary 6: Mesio-
distal widths of all teeth mesial
to maxillary first premolars are
measured and summed up.

4. Sum of mandibular 6: Mesio-

distal widths of all teeth mesial
to mandibular first premolars
are measured and summed up.

117
DETERMINATION OF OVERALL
RATIO
 According to Bolton, the sum of mesio-distal widths of
the mandibular teeth anterior to the second permanent
molars is 91.3% the mesio-distal widths of the maxillary
teeth mesial to the second permanent molars.

 The overall ratio is calculated as follows:

Overall ratio = Sum of mandibular 12 x 100

Sum of maxillary 12
118
  If overall ratio is less than 91.3%, it indicates maxillary
tooth material excess.

 Maxillary excess is determined by the following

formula:

Maxillary overall excess = Maxillary 12 – Mandibular 12 x 100

91.3

119
 If the overall ratio is more than 91.3%, it indicates
mandibular tooth material excess.

 The amount of mandibular tooth excess can be

calculated as follows:

Mandibular overall excess = Mandibular 12 – Maxillary 12 x 91.3

100

120
 DETERMINATION OF ANTERIOR RATIO

 The sum of the mesio-distal widths of the mandibular

anteriors should be 77.2% of the mesio-distal widths of
the maxillary anteriors.

 The anterior ratio is calculated as:

Anterior ratio = Sum of mandibular 6 x 100

Sum of maxillary 6

121
 If the anterior ratio is less than 77.2%, it indicates
maxillary anterior excess.

 Maxillary anterior excess can be calculated as:

Maxillary anterior excess = Maxillary 6 – Mandibular 6 x 100

77.2

122
 If the anterior ratio is more than 77.2%, it indicates
mandibular anterior excess.

 It can be calculated as follows:

Mandibular anterior excess = Mandibular 6 – Maxillary 6 x 77.2

100

123
124
 BOLTON RATIO IN A NORTH INDIAN
POPULATION

 A study was conducted on 110 study casts by Shastri et

al in 2015 in North Indian population.

 Results showed mean total Bolton ratio of 91.36 ± 2.13

and a mean anterior Bolton ratio of 78.14 ± 4.09 were
found for the sample.

Shastri D et al. Bolton ratio in a North Indian population with different malocclusions.
J Orthodont Sci 2015;4:83‑5. 125
 THE DENTAL VTO: AN ANALYSIS OF
ORTHODONTIC TOOTH MOVEMENT
 The dental VTO consists of three charts:

1. Chart 1 records the initial midline and first molar

positions with the mandible in centric relation.

126
2. Chart 2 measures the lower arch discrepancy.

127
 Chart 3 records the anticipated treatment change in terms
of dental movements of the first molars, canines, and
midline.

128
 CONCLUSION

 This simple analysis is most helpful as a diagnostic and

treatment-planning aid and as a reference throughout
treatment. It is also useful in making the extraction/non-
extraction decision.

129
 DIGITAL MODEL ANALYSIS
 Digital models are rapidly replacing plaster models.

 Measurements on the dental cast can be carried out on

digital models without the cumbersome use of callipers.

 Many softwares have been developed which perform all

the analysis on these digital casts without any human
error.
130
DIGITAL MODEL ANALYSIS

131
 REFERENCES
 Moyers R. E : Hand book of orthodontics, 4th edition,
1988 page 221 – 248.
 Tanaka MM, Johnson; The prediction of the size of
unerupted canine and premolars in a contemporary
othodontic population. Journal Am Dent Assoc 1974; 88:
798 – 801.
 HUCKABA G W : Arch size analysis and tooth size
prediction. Dent clin North Am 1964; 11: 431 – 40.
132
 REFERENCES
 Hixon E H, Old father R E : Estimation of the size of
unerupted cuspid and bicuspid teeth, Angle Othodontics
1958; 28: 236 – 40.
 Stanly RN, Kerber PE : A revision of the Hixon and old
father mixed-dentition prediction method, AJO 1980; 78:
296 – 30.
 Thomas M Graber, Robert Vanarsdall : Orthodontics-
current principles and techniques; 2nd edition 2004 page
439 - 450. 133
 REFERENCES
 Robert H. Kirschen, Elizabeth A. O’Higgins, and Robert
T. Lee: The Royal London Space Planning: An integration
of space analysis and treatment planning. Part I :
Assessing the space required to meet treatment objectives.
Part II : The effect of other treatment procedures on space.
AJO-DO October 2000, vol 118:448 – 456.
 Bolton WA. The clinical application of a tooth size
analysis. Am J Orthod. 1962;48:504.
134
 REFERENCES
 Carey CW. LINEAR ARCH DIMENSION AND
TOOTH SIZE. Am J Orthod. 1949;35(10):762-75.
 Joondeph D, Riedel R, Moore A. Pont’s index: A clinical
evaluation. Angle Orthod. 1970;40(2):112-19.

135