Journal of the Werl Federation of Othodontist 2 (2013) e49-851 Contents lists available at SciVerse ScienceDirect, Journal of the World Federation of Orthodontists journal homepage: www.jwfo.org Research Tooth size discrepancy: Is the E space similar to the leeway space? Luciana QP. Fernandes*", Rhita C. Almeida’, Barbara N.G. de Andrade*, Felipe de Assis R. Carvalho*, Marco Antonio de O. Almeida®, Flavia R.G. Artese® Deparment of Oot, Ri de Ji tt Universi Ro de oes, Brat *profesar end Charman Department of Ortadontice io be one Sate University is de Jae, Bi “asocite Potssor Deparent of Othodonts, Re de Jane State Unters. Re de one, Bra ARTICLE INFO ABSTRACT iackground The space for perfect positioning of permanent cet is usually aiteal in both deatal arches, particulary in the lower one. The use of the leeway space allows better management of space deficiency. ‘Many orthodontists use the & space, instead of the leeway space, because it is easier to measure and because they believe thatthe two measurements wil be sala ‘bjective: The purpose ofthis study was to evaluate the veracity of this hypothesis ‘Methods: in all 104 plaster casts of the lower jaw of 52 persons in the mixed dentition and in the permanent dentition were used, The leeway space and the Espace were calculated by the same examine? Using a digital caliper with accuracy of 001 mam, The method error demonstrated an excelent comelation Results: The D'Agostino Ces demonstrated that all variables presented a normal distribution, and the paired ¢ test showed significant ciffeence (p ~ 0.0001) between the mean values of all measurements, ‘with higher values forthe space. The mean diference found was 0.5 mm foreach side, which can be onsidered clinically relevant Conclusions: The results show that the E space predicts larger space than the leeway space, and this ined! éetivon| Preventive orthodontics ditference was approximately 1 mm. Therefor, clinicians shouldbe careful not to overestim svailable the space © 2013 World Federation of Orthodontists 1. Introduction There is a growing emphasis on preventive and interceptive orthodontics because it may prevent or reduce the severity of ‘malocclusions in the permanent dentition 1]. Crowding and inregularity are the most prevalent types of malocclusion in dental patients [24], and to attain correct alignment and leveling of the teeth, space is necessary. The first space analysis was conducted by Nance in 1947 [5]. This analysis consisted of comparing the amount of space available for the alignment of the teeth to the amount of space required for proper alignment, using radiographs and prediction tables to analyze the tooth sizes. Subsequent, other methods were des cried that attempted to simplify the analysis for clinicians, such as the method described by Tanaka and Johnston [6], which did not require radiographs or prediction tables. ~TGoresponding author: Rus Desembargador tsa, 155/705, Tues, Ra de Jae 20521160, Ri de Jane, ea "Ema odires!iptenandesOhatnal cor LOP.Fetandes} The most important space available for alignment of the permanent teeth, primarily in the lower arch, is the leeway space, defined by Nance [5] as the space resulting from the difference between the mesiodistal dimension of the primary canine, fst and second molars, and the permanent canine, first and second premolars. By studying x-ray films and plaster casts, he concluded. that the lower leeway space should be approximately 17 mm. fon each side and that the upper leeway space should be approxi ‘mately 09mm per side. In addition o dental alignment, the leeway space is also used to attain correct occlusion between the first permanent molars when there is a straight terminal plane in the deciduous dentition, as there is a mesial space into Which the first permanent molar can physiologically migrate [4,5,7—1] There is a hypothesis that the leeway space is approximately equivalent to the E space, which is the difference between the ‘mesiodistal dimensions of the second primary molar and second premolar, considering that the combined mesiodistal dimensions of the primary canine and first molar are similar to the combined ‘mesiodistal dimensions ofthe permanent canine and first premolar [2], whereas the second primary molar has the greatest differenceso QP Fenonde et ara in the mesiodistal dimension compared with its successor {12,13} The E space involves a simpler calculation and is being used by several clinicians and researchers [2,14], even though it was not developed in any study comparing both measurements, ‘Therefore, the aim of this study was to determine whether the E space can be used instead of the leeway space in mixed dentition analysis. 2. Methods and materials For this study, 104 plaster casts from 52 patients in the Ortho- ontic Clinic of Rio de Janeiro State University were used. This research was submitted and approved by the University Ethics Committee (CEP/HUPE: 2862/2011). The sample inclusion criteria were patients who had plaster casts of the lower arch in the mixed dentition, revealing erupted permanent incisors, primary canines and molars, and the first permanent molars, and plaster casts of the lower arch in the permanent dentition. Hemiarches were excluded from this study if there were fractures in the plaster that could compromise the _measurements, missing teeth, partially erupted teeth or any dental shape or size anomaly. as well as carious lesions or restorations that could alter tooth size. Ifthe other hemiarch did not present any of thse changes, it was kept in the sample, In toral,the study sample included 100 hemiarches. The leeway space and the E space of each patient were calcu- lated by the same examiner, All measurements were performed with a digital caliper with an accuracy of 0.01 mm, ‘To calculate the leeway space, the largest mesiodistal dimen- sions of the primary canines and molars in the mixed dentition casts and the premolars and canines in the permanent dentition casts were measured, Both molars and premolars were measured Using the occlusal surface, and the permanent and primary canines ‘were measured using the buccal surface. The leeway space was calculated as the difference between the sum of the mesiodistal dimensions of the primary canines and molars, permanent canines, and premolars. The E space was then calculated using the difference between the mesiodistal dimensions of the primary second molars and second premolars To determine the method error, the mixed and permanent dentition casts of five randomly selected patients were used. All _measurements were performed twice, with an interval of2 weeks, by the same examiner. The intraclass correlation coefficient rev- ealed excellent reproducibility of the measurements (intraclass correlation coefficient = 0.98), indicating that the method used was reliable Statistical analysis was performed using BioEstat 5.0 software. The DAgostino normality test was used to evaluate variable distribution, and the paired r test was used to compare the leeway space and the E space. The Pearson correlation test was used to compare the variables, 4, Results and discussion The D'Agostino normality test indicated a normal distribution {or the sample, and a descriptive analysis ofthe sample is shown in Table |. Hecause the sample consisted of hemiarches, the average of the leeway space as well as the E space for the right and the left sides were compared, and there were no significant differences between them. Therefore, the right and left sides were compared together, The paired ¢ test indicated a significant difference between the means of the two measurements (p < 0.001), with higher values for the E space (Fig. 1). The Pearson correlation test produced a cortelation scote of 0.643, which was significant at the (0.01 level (Table 2) the Wold Federation of Orthodontists 22012) 48-051 Deseipve analysis Median ao 2498, Seandaed Deviation “ses? O05 imma as 8 Nm So 364 ‘This study used plaster casts of the lower arch inthe mixed and ‘permanent dentition ta calculate the leeway space and the E space, Clinicians usually obtain these measurements by using prediction tables or radiographs, as described by Nance [5], but because this ‘was a retrospective study, plaster casts were used to avoid the distortion of the x-ray film and obtain more reliable measurements. The methodology used was similar (o that of previous studies 1,8~10,12,13.15.16], and the method error analysis revealed excel- Tent correlation, indicating that the results in this study can be considered reliable and accurate. A digital caliper with an accuracy ‘0f 0.01 mm was also used by other studies for tooth measurements 142.1316}, with inclusion criteria [1,12] and exclusion criteria 12,1316] similar to those presented in this article. Most previous studies did not specify which landmarks were used for the tooth ‘measurements, and no pattern was found between the studies that did specify the regions used. Pacheco et al. [12] performed most ‘measurements of the molars and premolars on the buccal surface; however, in some cases where there was crowding, the measure :ments were obtained by placing the ends of the caliper parallel to the long axis of the tooth, directed by the occlusal surface. To standardize all measurements, in this study the occlusal surface ‘was used for all molars and premolars in the sample. Yuen etal [13] measured each tooth twice and considered the actual size of the tooth to be the average of these two measutes. Because the method ertor of the present study indicated excellent cortelation, each tooth was measured only once, This study considered both sides of the arch, without dis- tinguishing the right from the left side because no significant differences were found between them, Yuen et al. [16] demon- strated that bilateral asymmetry was statistically significant at the 10.01 level only for the upper second primary molar, and the amount ofthis asymmetry was actualy small. Therefore, averaging the sizes of antimere teeth should not have significantly affected the results. This concept isin agreement with the usual practice of using teeth fon one side of the jaw to predict the size ofthe teeth on the other side (16,7), : I I | Fg 1. The means (columns) and standard deviations (rrr bas) forthe total ightQP Femander ea urna of he Word Federation of Ortadanit 2 (2018) e8-e51 ce Rese ofthe Parson correlition tes ae. In this study, when comparing the mean values found for the leeway space and the E space, a significant difference was found (p < 0.001), with higher values forthe F space. The mean difference found was approximately 0.45 mm on each side, which represents approximately | mm in total tooth size discrepancy. in addition, the Pearson correlation test indicated a moderate correlation of 0.643, ‘Therefore, because the E space predicts a larger space than the leeway space, the clinician should be careful not to overestimate the {otal space available for correct alignment of the permanent teeth Despite the clinical importance of this topic, no articles were found that compare the leeway space and E space. The calculations for the E space are much simpler than for the leeway space, and clinicians often use the E space, even though there are no studies proving its validity. Gianelly [2 in a study involving the use of the leeway space forthe resolution of crowding in the mixed dentition, considered the leeway space and the E space to be equivalent. In that article, the investigator compared the sum of the mesiodistal dimension of the canine and the first primary molar (13.64 mm) (0 the permanent canine and first premolar (13.85 mm), affirming that those measurements were nearly equivalent. Williams [14] considered the leeway space to be the difference between the second deciduous molar and the second premolar, which in fact is the definition of the E space. Conversely, this equivalence was not ‘observed in the present study, 4. Conclusions The results of this study indicated significant difference between the leeway space and the E space, with higher values for the E space. This finding suggests that, when using the E space, clinicians should be careful not to overestimate the space available. References [1] Nanda RS, Chawla JM. Variablity of leeway space. J Indian Dent Assoc [3] Glanely AA. crowing: timing of treatment Angle Orthod 1994:64:415—8, 1A Nea Ae Ree Managemen of ace tems the pinay 15] Nance HR The limtatens ‘of rthodanic uearent: mated dente Tanaka MM, Johnston LE. Te prediction ofthe sizeof unerupted canines and premolars in a centemporary erthedentic population J Am Dent Assoc Baume I. Physiological tooth migration and its significance fr the develop- iment of occlusion: the biogenesis of accessional dentin. J Dent Res 950;28:331~7 Moores CFA. Growth changes ofthe dental {| Moorrees CF, Reed RB. Changes in dental arch dimensions expressed on the bacie of tooth eniption as meanire of Biologie age] Dent Ret 1965:44-128—41 [10] Moorrees CF, Chadha JM. Avaliable space for the incisors during dental devlopnnt—a gro stuly bsed on physio age Angle Cred arch dimension” a systematic review. Am J Orthed Dentefacal drthep [12] Pacheco MR. Yared KEG, Tovres HO, Petelea T.beeway space assessment 2 Beata sale i Bea Honzote iy, RBC Revita Tt de Cite 113] Yuen Kk Tang ELS LL. Relations between the mesiogistal crown diameters ‘of the primary and permanent teeth of Hong Kong Chinese. Arch Oral Bol [14] Witiams DR. The borderine patient and conservative treatment in the Ite ‘ined éenstion. Arm } Orthod 1977:71-127—35. [15] Inoue N, Kuo CH, Ke G, etal Infuence of tooth-ce-denture-base discrepancy ‘on space closure following premature less of deciduous teeth. Am } Orthod [16] Yuen KK, So U, Tang El. Mesiodstt crown diameters of the primary and ‘permanent teeth in southern Chinese-a longitudinal study. Eur] Orthod ioor-is71—31 [17] Margets 8, Brown T. Crown diameters of te deciduous teeth in Australian ‘Nborginals. 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