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orthodontic patients
John E. Freeman, DDS, a A. J. Maskeroni, DDS, b and Lewis Lorton, DDS, MSD c
O n e of the goals in comprehensive orthodontic treatment is to obtain an optimal final occlusion, overbite, and overjet. There are many factors that will influence the attainability of this goal,
one of which is the relationship of the total mesiodistal width of the maxillary teeth to that of the
mandibular teeth. A significant variation in this
relationship should be compensated for in the
treatment planning by considering esthetic bonding, prosthetic recontouring, stripping of enamel,
extraction, leaving spaces, or changing the desired
anterior overjet or overbite. The alternative to not
doing any of these may result in compromising the
occlusion in the buccal segments, an undesirable
result.
There has long been an understanding that a
certain maxillary-to-mandibular tooth size relationship was important for proper occlusal relationships. Over the years many investigators have attempted to quantify this relationship. In 1923 Gilpatric calculated that the total mesiodistal tooth
diameters in the maxillary arch exceeded that in
the mandibular arch by 8 to 12 ram. a Ballard, in
1944, evaluated 500 sets of models of orthodontic
patients and found that 90% possessed mesiodistal
From the U.S. Army Orthodontic Residency Program, Fort Meade, Md.
The views expressed in this article are those of the authors and do not
reflect the official policy of the Department of Defense or other Departments of the United States Government.
aLieutenant Commander, Dental Corps, United States Navy; Senior
Resident.
bCommander, Dental Corps, United States Navy; Clinical Instructor.
CConsultant, Statistics and Research Design.
Reprint requests to: Dr. John E. Freeman, Dental Department, U.S.
Naval Hospital, Great Lakes, IL 60088.
8/1/58926
24
Anterior ratio =
25
Table I. Statistical comparison Bolton study versus Fort Meade study. Overall "12" ratio
Sample size
Mean
Median
Range
Standard deviation
Standard error of mean
Coefficient of variation
Bolton
Fort Meade
55
91.3
Not available
87.5-94.8
1.91
0.26
2.09%
157
91.4
91.3
82.8-99.4
2.57
0.21
2.81%
Table II, Statistical comparison Bolton study versus Fort Meade study. Anterior "6" ratio
Sample size
Mean
Median
Range
Standard deviation
Standard error of mean
Coefficient of variation
Bolton
Fort Meade
55
77.2
Not available
74.5-80.4
1.65
0.22
2.14%
157
77.8
77.9
68.4-87.9
3.07
0.25
3.95%
26
20
19
~!~ l
< 87.5
87.5-89.3 89.4-91.2
91.3
91.4-93.2 93.3-95.1
> 95.1
Fig. 1. Fort Meade orthodontic cases. Overall " 1 2 " ratio: 91.3 = Bolton's mean. 89.4 to 91.2 and
91.4 to 93,2 are within 1 SD. 87.5 to 89.3 and 93.3 to 95.1 are outside 1 SD, but with 2 SD. <87. 5
and >95.1 are outside 2 SD.
< 73.9
73.9-75.4
75.5-77.1
7;~.2
77.3-78.8 78.9-80.5
>
80.5
Fig. 2. Fort Meade orthodontic cases. Anterior " 6 " ratio: 77.2 = Bolton's mean. 75.5 to 77.1 and
77.3 to 78.8 are within 1 SD. 73.9 to 75.4 and 78.9 to 80.5 are outside 1 SD, but within 2 SD. < 73.9
and >80.5 are outside 2 SD.and >95.1 are outside 2 SD.
These findings suggest that a large number of patients presenting for orthodontic treatment possess a
Bolton tooth-size discrepancy that may influence treatment goals and results. This study found 30.6% of
orthodontic patients to have a significant anterior toothsize discrepancy compared with the 22.9% found by
Crosby and Alexander. 7 Perhaps the difference may be
explained by the patient selection process in a military