Rinchuse

11/4/08

11:59 AM

Page 383

Donald J. Rinchuse, DMD,

MS, MDS, PhD1
Sanjivan Kandasamy, BDSc,
BScDent, DocClinDent,
MOrthRCS2

IMPLICATIONS OF THE INCLINATION

OF THE MANDIBULAR FIRST MOLARS
IN THE EXTRACTIONIST VERSUS
EXPANSIONIST DEBATE
Some orthodontic expansionists (versus extractionists) hold a notion
that in the decision to treat nonextraction, expansion treatment can
be predicated and dictated based on the degree of facial-lingual inclination of the mandibular molars (particularly the mandibular first
molars). For instance, some modern-day expansionists argue that
mandibular first molars with a facial crown lingual inclination of
approximately 30 degrees (based on Andrews measurement) indicate that the mandibular arch, and subsequently the maxillary arch,
needs to be developed or expanded to allow for more arch and
tongue space. However, this thinking is based on a false premise; the
mandibular first molars are normally lingually inclined approximately
30 degrees and not naturally found in an upright facial-lingual position of approximately 12 degrees. World J Orthod 2008;9:383390

here is currently a controversy in the

extractionist versus expansionist
debate involving the importance and correct value for the facial-lingual inclination
of the mandibular first molars: The relation of the facial-lingual inclination of the
mandibular first molars to normal occlusion, mandibular function, and orthodontic
stability is a complex subject. Nevertheless, it seems that orthodontic clinicians 13 who advocate nonextraction
treatments (usually with self-ligating
appliances) appear to believe that the
mandibular first molars normally have
an upright inclination (of about 0 to 12
degrees), not 30 degrees as found by
Andrews 46 and others 7,8 (this 30
degree value is typical and somewhat
variable depending on a number of factors, including facial type) (Fig 1). That is,

1Clinical

Professor of Orthodontics
and Dentofacial Orthopedics, University of Pittsburgh, School of Dental
Medicine, Pittsburgh, Pennsylvania,
USA.
2Research Associate, Department of
Orthodontics, School of Dentistry,
University of Western Australia, Nedlands, Western Australia; private
practice, Perth, Australia.
CORRESPONDENCE
Sanjivan Kandasamy
Department of Orthodontics
Oral Health Center of Western Australia
University of Western Australia
17 Monash Avenue
Nedlands, Western Australia 6009
Australia
E-mail: sanj@kandasamy.com.au

in situations in which the mandibular

first molars clinical crowns are lingually
inclined approximately 30 degrees or
more, nonextraction expansion orthodontic
treatment is warranted in order to produce an upright mandibular first molar
facial-lingual position (approximately 12
degrees) so that the tongue has more
room and the mandibular arch more
dimension (width)1,2 (Fig 1).
For instance, Alpern stated,1 . . . look
at the axial position of most posterior
mandibular molars (first or second). Evaluate whether or not these mandibular
molars are inclined axially toward the
tongue or not. In nearly every malocclusion, mandibular posterior molars have
crowns which are proclined in toward the
tongue . . . imagine how much uprighting
must be accomplished in order to reposi383

COPYRIGHT 2008 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO
PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER

Rinchuse

11/4/08

11:59 AM

Page 384

WORLD JOURNAL OF ORTHODONTICS

Rinchuse/Kandasamy

Fig 1 Diagram illustrating the correct lingual inclinations of the mandibular and
maxillary first molar crowns compared to
the inclinations advocated by the expansionists/nonextractionists.
Mandibular
molar
30 degrees
Mandibular
molar
10 degrees

tion these molars and the rest of the buccal segments (molars and bicuspids) to a
normal upright position. . . .
In a similar light, some influential
nonextraction orthodontists2,3 appear to
be arguing for a new paradigm in orthodontics that supports the view that lowfriction self-ligating brackets can magically allow arches to be expanded
(without the need for maxillary arch
palatal suture expansion) or developed
to accommodate severe tooth-sized arch
length discrepancies.
Damon wrote, 3 Extensive clinical
results indicate that clinicians now can
maintain most complete dentitions, even
in severely crowded arches, by using very
light-force, high tech arch wires in the
passive Damon appliance that alter the
balance of the forces among the lips,
tongue, and muscles of the face. This
alteration creates a new force equilibrium that allows the arch form to reshape
itself to accommodate the teeth; the
body not the clinician determines where
the teeth should be positioned . . . this
compelling research calls for a significant shift in thinking and treatment planning, reducing and even eliminating the
need for molar distalization, extractions
(excluding those deemed appropriate for
bimaxillary protrusive cases), and rapid
palatal expansion.
Although such nonextraction thinking
is argued as new and contemporary, it
seems that it is an argument Angle
offered some 100 years ago.9,10 If one
studies 2 figures in the textbook these
clinicians referenced, some illuminating
information can be extricated.1 For example, when one looks at the first diagram
that illustrates what the author1 believes

to be deficient tongue space due to

abnormally lingually inclined mandibular
molars, one finds that these teeth have
normal Andrews inclinations4,5; when
measured from the textbook, they are
approximately 30 degrees (crown inclination from the facial sur face as
described by Andrews 4 ). 1 And if one
repeats this same procedure for the second diagram, which purportedly represents the correct/normal inclination for
these molars, a value of approximately
12 degrees is obtained. Obviously, this
clinician and author1 believe that the correct and optimal inclination (as described
by Andrews4,5) for mandibular molars is
somewhere around 12 degrees.
If similar measurements are performed from illustrations in a chapter of
another prominent orthodontist arguing
for nonextraction, expansion, orthodontic
treatment based on the lingual inclination of the mandibular first molars, a
similar finding is evident.11 The drawing
representing what the author believes to
be a normal inclination for these teeth is
approximately 15 degrees, and the
drawing representing what is believed to
be a constricted mandibular arch (presumably in need of expansion) is approximately 28 degrees.11 Once again, this
clinician is making treatment-planning
decisions based on a false notion of
what constitutes the correct facial-lingual
inclination of the mandibular first
molars. And again, this clinicians view is
in disagreement with the findings of
Andrews4,5 and others7,8 (Fig 1) that the
correct inclination of the mandibular first
molar is approximately 30 degrees, not
15 degrees. In this regard, McNamrara 12 recently wrote, Our long-term

384
COPYRIGHT 2008 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO
PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER

Rinchuse

11/4/08

11:59 AM

Page 385

VOLUME 9, NUMBER 3, 2008

Rinchuse/Kandasamy

Fig 2 Diagram illustrating lingual inclinations of the mandibular and maxillary first
molar crowns, as well as the inward (lingual) tilt of the mandibular corpus.
Maxillary
molar
9 degrees
Mandibular
molar
30 degrees

research has indicated that patients with

mild to moderate crowding can be managed effectively with RME, especially
those whose mandibular posterior teeth
initially are tipped lingually. Another
nonextraction view seems to imply that
arch expansion (including expanding the
mandibular arch to match an expanded
maxillary arch) is an important consideration in achieving optimal esthetics,1,3
carried out to achieve broader smiles
and eliminate or reduce so-called dark
buccal corridor spaces.13
The foregoing arguments for nonextraction orthodontic treatment, particularly those based upon an upright faciallingual inclination of the mandibular first
molars, can be legitimately challenged
for a number of reasons.

Correct inclination of the

mandibular first molars
First and foremost, the normal crown
inclination value for the mandibular first
molar for Caucasians is approximately
30 degrees, 48 not straight upright
(approximately 0 to 12 degrees) as several clinicians conject.13,11 Andrews14
argued for using the clinical crowns
rather than the long axis for judging
facial-lingual inclination based on a pragmatic viewpoint; ie, in everyday clinical
practice, only the crowns of the teeth are
available to the practitioner. Andrews14
wrote, As orthodontists, we work specifically with the crowns of teeth and, therefore, crowns should be our communication base or referent, just as they are our
clinical base. Andrews measurements
(ie, point of tangency or LA point) were

taken from the midpoint of the facial surface of the clinical crown: . . . a line perpendicular to the occlusal plane and a
line tangent to the middle of the labial or
buccal long axis of the clinical crown.14
Andrews found that all posterior teeth
(maxillary and mandibular as judged
from the clinical crowns of the teeth) are
lingually inclined, and this is clearly illustrated in his Six Keys article. 14 Concerning the inclination of the mandibular
posterior teeth, Andrews wrote,14 A progressively greater minus crown inclination (approximately 11 to 35 degrees)
existed from the lower canines through
the lower second molars. Parenthetically, this finding of Andrews is in line
with that of a renowned anthropologist B.
Holly Smith, 15 who wrote Hominoid
molar teeth are progressively tilted. The
normal/ideal facial-lingual inclination for
the clinical crowns of the mandibular
first molars (in Caucasians) as developed
in the bracket prescription of the original
Andrews (A-Company) appliance 46 is
30 degrees (Fig 2). The typical straightwire (preadjusted) prescription for the
mandibular first molars for most orthodontic companies and practitioners is
30 degrees (plus or minus several
degrees; some prescriptions have 25
degrees). Lee and Rinchuse16 found that
the inclination of the mandibular first
molar crowns for Asians (Koreans) was
26.96 degrees.
This 30-degree inclination angle for
the mandibular first molar is the same
as what Vardimon and Lambertz7 inidicate. Furthermore, the classic 1963
study by Dempster et al8 of 11 male dry
skulls (India) with typical occlusions
demonstrated that the inclination of the
385

COPYRIGHT 2008 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO
PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER

Rinchuse

11/4/08

11:59 AM

Page 386

WORLD JOURNAL OF ORTHODONTICS

Rinchuse/Kandasamy

Line of force

there is some controversy as to whether

there is significant variability of the facial
crown contours of teeth amongst subjects.1924 Some data support the view
that there is a very limited range of dental facial crown surface curvature.19,20
Conversely, other data support the opposite notion, which argues that the facial
contours of the teeth are not the same in
all individuals and are quite variable, particularly for certain tooth types.7,2124

Appliance prescription
Fig 3 Diagram illustrating the inward
motion and movement of the mandible on
the right working side during the trituration
phase of mastication.

roots (ie, the long axis of the whole tooth)

of the mandibular first molars was 32
degrees. (Dempster et al8 reported 58
degrees, but they used the outside
angle, not the inside angle as Andrews
did. When the corresponding Andrews
angle is calculated and measured from
Dempster, it is 32 degrees.)
As previously stated and reported by
Andrews,46 the maxillary posterior teeth
(crowns) are also lingually inclined
(approximately 9 degrees for the maxillary first molars), 46,8 but not to the
extent of the mandibular posterior teeth.
Parenthetically, if one judges from the
long axes (ie, through the roots) of the
maxillary molars (versus the facial surfaces of the teeth crowns as described
by Andrews14), these teeth actually have
a buccal inclination,8 not a lingual inclination. The mandibular first molar
crowns are more lingually inclined than
the maxillary first molar crowns in a ratio
of approximately 3:1 (ie, 30 and 9
degrees, respectively) (Fig 2). The inclinations of the maxillary and mandibular
posterior teeth and their interarch relationship help determine the curve of Wilson.
The curve of Wilson (or curve of Monson)
refers to the transverse occlusal curve
for each pair of left and right posterior
teeth; the curvature is concave and convex in the mandibular and maxillary dental arches, respectively, in the unworn
dentition. 17,18 It should be noted that

Curiously, nonextractionists advocating

the use of an incorrect lingual inclination
of the mandibular first molar as a diagnostic criterion for extraction/nonextraction
treatment are using a preadjusted appliance that probably has built-in torque
(inclination) values of approximately 25
to 30 degrees.13 How can cases exhibiting tilting of the mandibular molars
(approximately 30 degrees) be judged in
need of nonextraction and arch expansion, while at the same time, these clinicians are using a preadjusted appliance
with a prescription of approximately 30
degrees? It seems that the only ways the
nonextraction orthodontists can avoid 30
degrees of inclination (assuming they are
using a preadjusted appliance) as an outcome of treatment is to override the prescription by arch expansion (and not fully
engaging an edgewise slot) or deliberately
adjusting the crown torque (inclination) of
the posterior segment of the archwire.

Mandibular function
Humans chew unilaterally, and the chewing pattern shape (after the food is
incised) is described as elliptical and
tear-dropped when judged from the
frontal plane.25 Because the mandible
on the working side circles inward at an
angle of 20 to 35 degrees (depending
upon an individuals chewing characteristics during mastication), the mandibular
posterior molars also have to be lingually
inclined at a similar angle to best receive
an inward direction of force. It therefore
makes sense that the mandibular first

386
COPYRIGHT 2008 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO
PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER

Rinchuse

11/4/08

11:59 AM

Page 387

VOLUME 9, NUMBER 3, 2008

Rinchuse/Kandasamy

molars are lingually inclined in order not

to have an impending functional interference with the maxillary posterior teeth
(Fig 3). Furthermore, this design allows
for masticated food to be directed inward
toward the tongue as opposed to outward toward the cheeks, ensuring more
efficient chewing. 26 By studying the
anatomy of the lateral aspects of the
mandibular corpus, it can be seen that
the human mandible is per fectly
designed and engineered to deliver its
masticatory forces at an inward, lingual
attack angle of approximately 30
degrees as governed by the unilateral,
elliptical chewing pattern evident in
man 27 (Fig 3). The human masticatory
system is complex, but nonetheless, it is
unmistakably designed to produce and
receive occlusal forces at an inward (lingual)
vector, not in a straight up-and-down,
vertical vector.
The maxillary first molars (facial surface crowns) are also lingually inclined
(9 degrees), with the mandibular first
molars inclined more than the maxillary
first molars in a ratio of approximately
3:1 (Fig 3). One possible explanation for
this is that during trituration the
mandible (and the mandibular teeth)
attacks the maxillary teeth at an inward
angle; therefore, the maxillary posterior
teeth (crowns) have functionally adapted
to best receive forces at an inward direction and avoid any occlusal interferences.
Of note, the long axes of the maxillary
first molars (ie, roots) are slightly buccally
inclined to biomechanically withstand
and dissipate the inward loading forces
from the mandible.

Stability
Nonextractionists who argue for the correctness of a more upright inclination for
the mandibular first molars (12 to 15
degrees as opposed to 30 degrees) in
order to give the tongue more room often
cite as evidence the so-called equilibrium
theory.28 According to this theory,28 the
position of teeth within the arches is significantly influenced by the tongue, muscles, soft tissues of the cheeks, and
occlusal function. This theory has merit,

but the way it is spun for use by many

nonextractionists is disparagingly inappropriate. In fact, the equilibrium theory
better supports the counterargument
that the dental arches (particularly the
mandibular arch) should generally not be
expanded because the patients current
and existing arch dimensions are already
in a state of homeostatic equilibrium and
balance. To wit, the preservation of the
existing harmonious and stable position
of the teeth is usually argued by orthodontic extractionists (not nonextractionists)
for the need to remove teeth in order to
resolve severe tooth-sized arch length
discrepancies.
Clearly, there is a strong argument10
and suppor ting evidence that the
mandibular intercanine, 10,2938 and to
some extent, inter-molar transverse
dimensions, 10,2936 are somewhat
immutable and stable (with a slight
reduction with age), and any appreciable
expansion is doomed for relapse (unless,
of course, this can be counteracted by
lifetime retention). 31 Maxillary palatal
suture expansion is clearly an exception.
Studies have demonstrated that
mandibular intercanine width, unlike
intermolar width, is capable of withstanding only a slight increase (an average of
0.5 mm).3942
Despite the abundant literature that
exists supporting the fact that expansion
(especially in the intercanine region) of
the mandibular arch is essentially unstable and that the mandibular arch is generally the best guide for the success of
expansion, there appears to be a trend
toward planning treatment around the
clinicians ability to expand the maxillary
arch. 12,43,44 From a pragmatic view, it
should be noted that if 1 mm of maxillary
intermolar expansion provides approximately 0.6 mm of arch space, 45 one
would need to expand the maxillary intermolar width by 10 mm to address a moderate tooth-sized arch length disrepancy
of 6 mm. This essentially means that the
mandibular arch would need to be
expanded a similar amount to match the
newly expanded maxillary arch. In regard
to stability, Gianelly stated, How does one
reconcile the instability of an expanded
mandibular intercanine dimension with
387

COPYRIGHT 2008 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO
PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER

Rinchuse

11/4/08

11:59 AM

Page 388

WORLD JOURNAL OF ORTHODONTICS

Rinchuse/Kandasamy

this treatment option?46 In an attempt

to address moderate mandibular arch
crowding early with the use of a Schwartz
appliance, OGrady et al47 found that in
the long term, there was an average loss
of 2 mm in mandibular arch perimeter
with resultant relapse of the mandibular
molar inclination toward the lingual. It
would seem then that expanding the
mandibular arch to gain arch length or
perimeter in the long term is inherently
unstable.
It does appear that the vertical facial
pattern may influence how well arch
expansion will be tolerated in nonextraction cases.4851 It is sometimes argued
that significant arch expansion is possible for low- versus high-angle facial
types.39,49 Nevertheless, it is difficult to
predict in which type of patient expansion will be stable.51
Considering the evidence and arguments for and against expansion, it does
not make much sense to expand the
mandibular posterior teeth to eventually
have them relapse to a pretreatment
arch dimension and/or an inclination of
approximately 25 to 30 degrees.39,49
We argue this viewpoint with the full
knowledge and understanding that the
antithetical view can produce cases
where significant arch development/
expansion has occurred. Our concern is
more about the stability of these
cases.2,3,11,12

Bite opening
Besides the issue of stability, one must
consider the potential negative side
effects of simple orthodontic arch expansion (as opposed to orthopedic expansion), such as an untoward bite opening.
That is, buccal crown tipping and extrusion may predispose to unnecessary bite
opening and possible negative overall
facial or lip esthetic outcomes. This is
especially critical in patients that exhibit
skeletal open-bite tendencies, large interlabial gaps, and severe Class II open-bite
skeletal patterns.50

Facial pattern and molar

inclination
There appears to be a relationship
between facial type and mandibular
molar inclination.5255 That is, individuals with higher mandibular plane angles,
longer lower facial heights (ie, Dolichofacial) and reduced bite forces, appear to
have narrower arches52,54 and more vertically (upright) positioned molars. 52,54
This perhaps indicates that molar inclination may in some way be influenced by
facial form.5254 It should be noted that
mandibular molars generally erupt lingually and move buccally throughout
growth as a result of tongue pressure
and masticatory function.56 We note this
to alert the reader to the fact that we do
realize that the 30-degree facial crown
inclination for the mandibular first
molars we have used in this paper is an
approximate value and that there are
certainly differences based on a number of
variables, including facial pattern.

CONCLUSIONS
The long-held belief and evidence suppor ting the concept of the relative
immutability of the perimeter of the
mandibular arch appears to be ignored
in favor of orthodontic therapies that are
indiscriminately nonextraction. The previous evidence-based notion that supports
the view that the mandibular intercanine
and possibly intermolar arch width
should generally not be expanded
beyond very modest limits is now being
challenged by some contemporary orthodontic treatments and philosophies. Stability, as well as stomatognathic function,
seems to be of little concern and has
given way to the allures of big, broad
smiles and the at-all-costs nonextraction
approach. In this regard, there are many
premises and fads in orthodontics that
have not withstood the test of time. Even
the great Dr Edward Hartley Angle was
deemed to be incorrect in his thinking
concerning the universal recommendation for nonextraction orthodontic treatment. One of Angles students, Dr
Charles Tweed, retreated approximately
100 of his own relapsed, nonextraction

388
COPYRIGHT 2008 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO
PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER

Rinchuse

11/4/08

11:59 AM

Page 389

VOLUME 9, NUMBER 3, 2008

Rinchuse/Kandasamy

cases with premolar extractions and

demonstrated successful, stable
results.9,10,57,58
With facial cone-beam CT scans coming of age, it is possible to take frontal
cuts/slices at the first molar level and
then accurately obtain normative inclination data. Inclination values for the
mandibular and maxillary first molars
could also be compared with the inward
inclination values for the lateral borders
of the mandibular corpus to better glean
information regarding the relationship
between form and function of the stomatognathic system. One could also determine if there is a relationship between
these inclination values in subjects with
various Angles malocclusions or subjects exhibiting various chewing and/or
craniofacial patterns. It would appear
that only when appropriate, normative,
baseline data are obtained will orthodontic diagnoses and posttreatment outcome
evaluations be enhanced.
There seems to be a fundamental and
functional reason for the lingual crown
inclination of all posterior teeth based
upon masticatory mandibular movements. That is, the mandible cycles
inward during the molar trituration stage
of mastication at an attack path angle
that appears to be equivalent to the lingual inclination of the mandibular
molars. The notion that orthodontic
extraction/nonextraction therapy can be
predicated based upon using an incorrect upright facial-lingual inclination (of
approximately 12 degrees) of the
mandibular first molars (as a basis for
normal) is detrimental to proper orthodontic patient care.

REFERENCES
1. Alpern MC. The Ortho Evolution: The Science
and Principles Behind Fixed/Functional/Splint
Orthodontics. New York: GAC International,
2003:104105, 271.
2. Borkowski R. The Damon system of self-ligating
brackets. Presented at the University of Pittsburgh, Nov 11, 2005.
3. Damon DH. Treatment of the face with biocompatible orthodontics. In: Graber TM, Vanarsdall
Jr RL, Vig KWL (eds). Orthodontics: Current
Principles and Techniques, ed 4. St Louis: CV
Mosby, 2005:753831.

4. Andrews LF. The straight-wire appliance.

Explained and compared. J Clin Orthod 1976;
10:174195.
5. Andrews LF. The Straight-Wire Appliance: Syllabus of Philosophy and Techniques. San Diego:
A-Company, 1974.
6. The A Company product catalog. San Diego:
A-Company, 1981:3251.
7. Vardimon AD, Lambertz W. Statistical evaluation of torque angles in reference to straightwire appliance (SWA) theories. Am J Orthod
1986;89:5666.
8. Dempster WT, Adams WJ, Duddles RA. Arrangement in the jaws of the roots of the teeth. J Am
Dent Assoc 1963;67:779797.
9. Wahl N. Orthodontics in 3 millennia. Chapter 6:
More early 20th century appliances and the
extraction controversy. Am J Orthod Dentofacial
Orthop 2005;128:795800.
10. Profitt WR, Fields Jr HW. Orthodontic treatment
planning: Limitations, controversies, and special problems. In: Profitt WR, Fields HW Jr. Contemporary orthodontics, ed 3. Philadelphia: CV
Mosby, 2000: 249253.
11. McNamara JA Jr. Treatment of patients in the
mixed dentition. In: Graber TM, Vanarsdall RL
Jr, Vig KWL (eds). Orthodontics: Current principles and Techniques, ed 4. St Louis: CV Mosby,
2005: 543577.
12. McNamara JA Jr. Long-term adaptations to
changes in the transverse dimension in children and adolescents: An overview. Am J
Orthod Dentofacial Orthop 2006;129(4 suppl):
S7174.
13. Moore T, Southard KA, Casko JS, Qian F,
Southard TE. Buccal corridors and smile esthetics. Am J Orthod Dentofacial Orthop 2005;127:
208213.
14. Andrews LF. The six keys to normal occlusion.
Am J Orthod 1972;62:296309.
15. Smith BH. Development and evolution of the
helicoidal plan of dental occlusion. Am J Phys
Anthropol 1986;69:2135.
16. Lee DJ, Rinchuse DJ. Comparison of the dental
occlusion of Caucasians and Koreans: Implications for the future of orthodontics. Korean J
Orthod 1993;23:3745.
17. Ash MM, Ramfjord S. Occlusion, ed 4. Philadelphia: WB Saunders, 1995:59.
18. Kaifu Y, Kasai K, Townsend GC, Richards LC.
Tooth wear and the design of the human dentition: A perspective from evolutionary medicine. Am J Phys Anthropol 2003;(suppl 37):
4761.
19. Andrews LE. The edgewise appliance origin,
controversy, commentary. J Clin Orthod 1976;
10:99114.
20. Wheeler RC. Dental Anatomy, Physiology, and
Occlusion. Philadelphia: WB Saunders, 1974.
21. Dellinger EL. A scientific assessment of the
straight-wire appliance. Am J Orthod 1978;73:
290299.
22. Morrow JB. The angular variability of the facial
surfaces of the human dentition: An evaluation
of the morphological assumptions implicit in
the various straight-wire techniques. Masters
thesis, St Louis University, St Louis, Missouri, 1978.

389
COPYRIGHT 2008 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO
PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER

Rinchuse

11/4/08

11:59 AM

Page 390

WORLD JOURNAL OF ORTHODONTICS

Rinchuse/Kandasamy

23. Taylor RMS. Variation in form of human teeth: I.

An anthropologic and forensic study of maxillary incisors. J Dent Res 1969;48:516.
24. Taylor RMS. Variation in form of human teeth.
II. An anthropologic and forensic study of maxillary canines. J Dent Res 1969;48:173182.
25. Ahlgren J. Mechanism of mastication. Acta
Odontol Scand 1966;24 (suppl 44):1.
26. Dawson PE. Evaluation, Diagnosis and Treatment of Occlusal Problems, ed 2. St Louis: CV
Mosby, 1989: 88.
27. Ash MM. Wheelers Dental Anatomy, Physiology, and Occlusion, ed 7. Philadelphia: WB
Saunders, 1993, 84101.
28. Proffit WR. Equilibrium theory revisited: Factors
influencing position of teeth. Angle Orthod
1978;48:175186.
29. Sinclair PM, Little RM. Maturation of untreated
normal occlusion. Am J Orthod 1983;83:114123.
30. Bishara SE, Jakobsen JR, Treder J, Nowak A.
Arch width changes from 6 weeks to 45 years
of age. Am J Orthod Dentofacial Orthop 1997;
111:401409.
31. Little RM, Reidel RA, Artun J. An evaluation of
changes in mandibular anterior alignment from
10 to 20 years of postretention. Am J Orthod
Dentofacial Orthop 1988;93:423428.
32. Little RM. Stability and relapse: Early treatment
of arch length deficiency. Am J Orthod Dentofacial Orthop 2002;121:578581.
33. Lagravere MO, Heo G, Major PW, Flores-Mir C.
Meta-analysis of immediate changes with rapid
maxillary expansion treatment. J Am Dent
Assoc 2006;137:4453.
34. Lagravere MO, Major PW, Flores-Mir C. Longterm dental arch changes after rapid maxillary
expansion treatment: A systematic review.
Angle Orthod 2005;155161.
35. Schiffman PH, Tuncay OC. Maxillary expansion:
A meta analysis. Clin Orthod Res 2001;4:8696.
36. Little R, Reidel R. Postretention evaluation of
stability and relapse: Mandibular arches with
generalized spacing. Am J Orthod Dentofacial
Orthop 1989;95:3741.
37. Burke SP, Silveira AM, Goldsmith LJ, Yancey JM,
Van Stewart A, Scarfe WC. A meta-analysis of
mandibular intercanine width in treatment and
postretention. Angle Orthod 1998;68:5360.
38. Moorees C. The Dentition of the Growing Child:
A Longitudinal Study of Dental Development
Between 3 and 18 Years of Age. Cambridge:
Harvard University Press, 1959.
39. Shapiro PA. Mandibular dental arch form and
dimension. Am J Orthod 1974;66:5870.
40. Uhde M.D, Sadowsky C, BeGole EA. Long-term
stability of dental relationships after orthodontic treatment. Angle Orthod 1983;53:240252.
41. Felton JM, Sinclair PM, Jones DL, Alexander
RG. A computerized analysis of the shape and
stability of mandibular arch form. Am J Orthod
Dentofacial Orthop 1987;92:478483.
42. Glenn G, Sinclair PM, Alexander RG. Nonextraction orthodontic therapy: Post-treatment dental
and skeletal stability. Am J Orthod Dentofacial
Orthop 1987;92:321328.

43. Sandstrom RA, Klapper L, Papaconstantinou S.

Expansion of the lower arch concurrent with
rapid maxillary expansion. Am J Orthod Dentofacial Orthop 1988;94;296302.
44. Buschang PH. Maxillomandibular expansion:
Short-term relapse potential and long-term stability. Am J Orthod Dentofacial Orthop 2006;
129(4 suppl):S7579.
45. OHiggins EA, Lee RT. How much space is created from expansion or premolar extraction?
J Orthod 2000;27:1113.
46. Gianelly A. Evidence-based therapy: An orthodontic dilemma. Am J Orthod Dentofacial
Orthop 2006;129:596598.
47. OGrady PW, McNamara JA Jr, Baccetti T,
Franchi Z. A long-term evaluation of the
mandibular Schwarz appliance and the acrylic
splint expander in early mixed dentition
patients. Am J Orthod Dentofacial Orthop
2006;130:202213.
48. Vaden JL. Nonsurgical treatment of the patient
with vertical discrepancy. Am J Orthod Dentofacial Orthop 1998;113:567582.
49. Riedel RA. A review of the retention problem.
Angle Orthod 1960;30:179199.
50. Sarver DM, Johnston MW. Skeletal changes in
vertical and anterior displacement of the maxilla with bonded rapid palatal expansion appliances. Am J Orthod Dentofacial Orthop 1989;
95:462466.
51. Bishara SE, Staley RN. Maxillary expansion:
Clinical implications. Am J Orthod Dentofacial
Orthop 1987;91:314.
52. Masumoto T, Hayashi I, Kawamura A, Tanaka
K, Kasai K. Relationships among facial type,
buccolingual molar inclination, and cortical
bone thickness of the mandible. Eur J Orthod
2001;23:1523.
53. Tsunori M, Mashita M, Kasai K. Relationships
between facial types and tooth and bone characteristics of the mandible obtained by CT
scanning. Angle Orthod 1998;68:557562.
54. Kiliaridis S, Georgiakaki I, Katsaros C. Masseter muscle thickness and maxillary dental
arch width. Eur J Orthod 2003;25:259263.
55. Kageyama T, Dominquez-Rodriquez GC, Vigorito
JW, Deguchi T. A morphological study of the
relationship between arch dimensions and
craniofacial structures in adolescents with
Class II Division 1 malocclusion and various
facial types. Am J Orthod Dentofacial Orthop
2006;129:368375.
56. Hesby RM, Marshall SD, Dawson DV, et al.
Transverse skeletal and dentoalveolar changes
during growth. Am J Orthod Dentofacial Orthop
2006;130:721731.
57. Tweed CH. Indications for the extraction of
teeth in orthodontic procedures. Am J Orthod
Oral Surg 1944;30:405428.
58. Tweed CH. Philosophy of orthodontic treatment. Am J Orthod Oral Surg 1945;31:74103.

390
COPYRIGHT 2008 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO
PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER