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Dental crowding and its relationship to mesiodistal

crown diameters and arch dimensions


D. Radnzic, BDS, MDSc, D.D. Orth., RCPS (Glasg.)
Rochdale, England

An investigation was carried out to determine the correlation among cumulative mesiodistal crown
widths, arch dimensions, and the degree of primary dental arch crowding. Two different ethnic groups
were studied-namely, indigenous British and Pakistani immigrant groups-to determine whether
similar correlations existed as part of a larger study of ethnic comparisons. Correlation matrix
computation and multiple regression analysis were among the tests used. The results showed that in
both ethnic groups there were very significant correlations between certain arch dimensions and
the degree of crowding. There was no significant correlation between cumulative mesiodistal crown
widths and dental crowding when considered in isolation. In combination with the other parameters,
however, cumulative mesiodistal crown widths contributed significantly to the overall regression
equation. This suggested a complex interrelationship among cumulative mesiodistal crown widths,
the various arch dimensions, and primary dental crowding. (AM J ORTHOD DENTOFAC ORTHOP
1988;94:50-8.)

N ante’ described dental crowding as the


difference between the space needed in the dental arch
Mills,7 in a survey of 230 male subjects, found a
significant association between crowding and arch
and the space available in that arch-that is, the space width, but no significant differences in tooth size or
discrepancy. Thus, crowding or spacing can be de- arch length between crowded and uncrowded arches.
scribed as an expression of an altered tooth/ tissue ratio Lundstr(im,8 in a study of Swedish males, showed
or as a dentoalveolar disproportion. that those with large teeth were more likely to have
The causes of crowding or spacing are, however, dental crowding than those with small teeth.
still not fully understood. Hooton’ suggested that Fastlichtg came to a similar conclusion and found a
crowding was probably the result of an evolutionary significant correlation between dental crowding and the
trend toward a reduced facial skeletal size without a mesiodistal dimensions of maxillary and mandibular
corresponding decrease in tooth size. permanent incisors. However, his sample size of 28
Brash3 said that crowding was hereditary, the result was rather small.
of interbreeding in ethnic groups who were physically Norderval, Wisth, and Bae’O showed a significant
dissimilar. Other investigators such as Barb& and relationship between dental crowding and tooth size in
Moore, Lavelle, and Spences suggested that environ- a study of two groups of Scandinavian adults exhibiting
mental factors (eg, soft diet and loss of arch length “ideal” and crowded mandibular arches, respectively.
caused by caries) were more important than genetic However, only incisor widths were measured.
factors, especially when ethnic groups were compared. Doris, Bernard, and Kuftinec” showed that tooth
Many investigations have focused on the part played size was uniformly larger in subjects with crowded
by tooth size and various arch dimensions in relation arches in a study of 80 North American subjects.
to dental crowding. Lundstriim,6 in a survey using max- McKeown,12 however, found a greater correlation
illary study models taken from 139 Swedish boys, with between dental arch size and crowding than between
a mean age of 13 years and with varying degrees of tooth size and crowding. He measured study models
crowding, found that as tooth size increased and arch taken from 65 subjects and found the correlation be-
perimeter decreased, the degree of crowding increased. tween arch width and crowding to be particularly high.
This led him to conclude that a narrow arch generally
predisposed to crowding.
This study was carried out in partial fulfillment of the requirements for the A recent investigation was carried out by Howe,
MDSc degree while the author was working in the Orthodontic Department of
the University of Leeds Dental Hospital. McNamara, and O’Connor,13 who studied the relation-
*Senior Dental Officer, Dental Department, Baillie Street Health Centre. ship among tooth size, arch size, and crowding. Two
Volume 94 Dental crowding 51
Number I

Fig. 1. Points of measurement of arch widths. Fig. 2. Arch length measurement.

groups of study models were used, one group obtained 2. No previous orthodontic treatment involving the
from 18 male and 32 female subjects who exhibited deciduous, mixed, or permanent dentitions in
gross crowding, the other from 24 male and 30 female either arch
subjects who exhibited little or no crowding. They 3. No large coronal restorations that might have
found that the two groups could not be distinguished altered both coronal shape and size
in terms of tooth size, but that arch dimensions in the 4. Models undamaged in areas of measurement
crowded group were generally smaller than in the non- For each pair of casts, the following parameters
crowded group. They concluded that dental crowding were recorded in each arch:
was associated with smaller dental arches, rather than 1, Cumulative mesiodistal crown widths
large teeth. 2. Arch width
Therefore, it would appear from the literature that 3. Arch length
conflicting evidence exists regarding the part played by 4. Arch perimeter
tooth size in the cause of primary crowding. Further 5. Estimate of dentoalveolar disproportion
investigations are required to clarify the situation be- The measurements were repeated for each cast, with a
cause it could have some bearing on the nature of treat- minimum period of 1 week between repeated measure-
ment provided for alleviation of such crowding. The ments. The method of making the measurements is
present investigation attempts to do this and also to described below.
determine whether similar findings apply in two ethnic
groups whose environmental and dietary backgrounds Cumulative mesiodistal crown widths
are somewhat dissimilar. The cumulative mesiodistal crown width was cal-
culated as the sum of mesiodistal crown widths of in-
MATERIALS AND METHOD dividual teeth in each arch up to and including the first
Sixty pairs of dental casts taken from indigenous permanent molars. Individual measurements were made
British boys in Leeds and 60 pairs of casts taken from with a vernier gauge to the nearest 0.1 mm, with the
Pakistani immigrant boys living in Rochdale, England, blades of the calipers held perpendicular to the long
were measured. Ages ranged from 13 years to 15 years axis of the tooth. I3
11 months. The samples were chosen at random (using
random number tables) from a larger sample in each Arch width
group that had met the selection criteria. The investi- Two dimensions of arch width were used:
gation was limited to male children of the aforemen- 1. Maximum distance between distal surfaces of
tioned age range for no other reason than availability. lateral incisors
The selection criteria were as follows: 2. Mean intermolar width as calculated from val-
1. All permanent teeth present in each arch (ex- ues obtained for buccal and lingual intermolar
cluding second and third molars) and in a suf- widths
ficient state of eruption to permit measurement Both buccal and lingual intermolar dimensions were
of the mesiodistal crown dimension measured from the point of intersection of the gingival
52 Radnzic Am. J. Orthod. Dentofac. Orthop.
July 1988

Table I. Comparison of mean values between crowded and noncrowded or spaced arches in the indigenous
British sample
Crowded arches Noncrowded arches
(-10 mm to +2.9 mm) (+3 mm to +25.9 mm)
Parameter t
(N = 60*) Mean (mm) Variance? Mean (mm) Variance? value

Maxilla
Cumulative crown widths 97.18 9.74 97.25 13.48 0.055 NS
Arch length 35.70 5.78 41.35 4.97 6.374$
Arch width 6-6 (mean) 41.91 18.67 46.88 18.08 2.998$
Arch width (lateral inci- 25.64 8.40 29.07 3.81 3.857$
sots)
Arch perimeter 96.90 15.87 109.50 22.47 7.210$
Mandible
Cumulative crown widths 90.20 6.76 89.48 11.64 0.550 NS
Arch length 31.69 1.97 36.86 2.81 7.809$
Arch width 6-6 (mean) 42.20 12.63 47.46 6.58 3.497t
Arch width (lateral inci- 20.55 7.12 24.10 4.11 4.5628
sors)
Arch perimeter 90.88 7.12 104.00 14.67 9.364$

*Denotes sample size.


I’ Denotes estimated population variance.
*Significant at P < 0.01.

margin with an extension gingival to the buccal and This method produced numerical values that were
lingual fissures of the first permanent molars. Mea- not significantly different (P < 0.01) from those ob-
surements were made with vernier calipers to the near- tained by direct measurements on the dental casts. How-
est 0.1 mm (Fig. 1). ever, it was found to be more reliable and far less time-
consuming than direct measurement. Variations in arch
Arch length shape did not appear to significantly influence the dif-
The measurement of arch length was accomplished ferences between calculated and directly measured val-
on each model with an engineering depth gauge, round- ues of arch perimeter (P < 0.01) in the samples studied
ing off to the nearest millimeter. in either of the ethnic groups.
For the present study, the arch length was defined
as the length of a perpendicular line from the contact Estimate of dentoalveolar disproportion
point between the permanent central incisors to a line No standard exists by which crowding or spacing
joining the distal surfaces of the first permanent molars can be expressed. Various indices have been sug-
(Fig. 2). gested. “-” However, it was believed that a numerical
estimate of space discrepancy would be more useful
Arch perimeter and easier to visualize.
This was calculated by means of a modification of The dentoalveolar disproportion or space discrep-
the formula suggested by Mills and Hamilton14: ancy was calculated as the numerical difference be-
tween the arch perimeter and the cumulative mesiodistal
Arch perimeter = 2 y2 + y crown widths (in millimeters) in each arch.lS In the
J present study, crowded arches were defined as those
where x = arch length, but substituting with a space discrepancy of +2.9 mm or less. Non-
crowded and spaced arches were defined as those
mean intermolar width with a space discrepancy of + 3 mm or more. The lim-
Y’ 2 its of the samples used in this study were - 10 mm
instead of to +2.9 mm for crowded arches, and + 3 mm to
buccal interrnolar width + 25.9 mm for noncrowded and spaced arches. A value
Y= of +2.9 mm space discrepancy was selected as the
2
baseline between crowded and noncrowded arches and
as suggested by Mills and Hamilton.14 not 0 mm as might be expected. This value was arbi-
Volume 94
Number 1
Dental crowding 53

Table II. Comparison of mean values between crowded and noncrowded or spaced arches in the Pakistani
immigrant sample
Crowded arches Noncrowded arches
(-10 mm to +2.9 mm) (+3 mm to +25.9 mm)
Pantmeter t
(N == 60*) Mean (mm) Variance? Mean (mm) Variancet value

Maxilla
Cumulative crown widths 97.51 39.37 99.02 26.56 0.621 NS
Arch length 35.60 18.04 42.93 9.92 4.864$
Arch width 6-6 (mean) 43.28 12.10 46.07 5.94 2.31 lf
Arch width (lateral inci- 27.95 9.63 30.67 1.05 3.077$
SOB
Arch perimeter 97.70 42.68 112.78 22.33 6.580$
Mandible
Cumulative crown widths 88.40 16.55 87.87 2.05 0.250 NS
Arch length 32.28 5.51 35.25 0.25 2.475 NS
Arch width 6-6 (mean) 42.38 7.47 44.71 5.29 1.580 NS
Arch width (lateral inci- 20.89 1.73 22.95 0.40 3.010$
sors)
Arch perimeter 90.00 19.65 99.25 7.58 3.962$

*Denotes sample size.


I’Denotes estimzed population variance.
$Significant at P < 0.01.

trary, but compensated for the slight discrepancy (in then made between these two ranges. No significant
borderline cas,es)between the calculated dentoalveolar difference (at P < 0.01) was found between the
disproportion and that which was observed clinically. crowded and noncrowded or spaced groups in cumu-
Often, it was difficult in such cases to distinguish clin- lative mesiodistal crown widths. This applied to both
ically between very slightly crowded and noncrowded the Asian and non-Asian ethnic groups. However, sig-
arches. Similarly, arches with a calculated space dis- nificant differences were observed (at P < 0.01) in arch
crepancy of 0 mm often would appear clinically to be lengths, arch widths, and arch perimeters between the
very slightly crowded. A slight shift in the baseline crowded and noncrowded or spaced arches in both
from 0 mm to + 2.9 mm was found to be adequate to groups. Tables I and II show that crowded arches have
compensate for these slight differences. smaller arch lengths, arch widths, and arch perimeters
To minimize random and systematic errors, all mea- than noncrowded or spaced arches.
surements were performed by a single observer as sug- A correlation matrix for the various parameters was
gested by Hunter and Priest.” All models were then computed. The correlation coefficients (r) for cumu-
remeasured, in a random order, with an intervening lative mesiodistal crown widths and arch dimensions in
period of at least 1 week to eliminate any possibility relation to the degree of dentoalveolar disproportion for
of memory bias. each ethnic group are shown in Tables III and IV.
No significant correlation was found between cu-
RESULTS
mulative mesiodistal crown widths and the amount of
The results of Student’s t tests used to assess be- dentoalveolar disproportion (at P < 0.01) in either of
tween mean values of the various parameters in both the ethnic groups. However, significant correlations
crowded and uncrowded or spaced arches within each were found between the various arch dimensions and
ethnic group are shown in Tables I and II. The rela- the amount of dentoalveolar disproportion (at P <
tionship among cumulative crown widths, arch sizes, 0.01) in both ethnic groups. The correlation between
and dentoalveolar disproportion was examined by di- arch width and dentoalveolar disproportion did not ap-
viding each ethnic group into two ranges-those with pear to be as significant in the Asian group as in the
noncrowded a.nd spaced arches ( + 3 mm to + 25.9 mm indigenous group; the reason for this is not fully un-
estimated space discrepancy) and those with crowded derstood. Arch length and arch perimeter, however,
arches (- 10 mm to +2.9 mm estimated space dis- showed a highly significant correlation in both ethnic
crepancy) . Comparisons of cumulative mesiodistal groups, even at P < 0.001.
crown widths and the various arch dimensions were To further examine me relationship between the var-
54 Radnzic Am. J. Orthod. Dentofac. Onhop.
July 1988

Table III. Correlations among cumulative crown widths, arch dimensions, and dentoalveolar disproportion
in the indigenous British group
Correlation under test Intercept A (mm) Gradient B r* t value

Cumulative crown widths and dentoalveolar disproportion


Maxilla +11.32 -0.04 0.034 0.244 NS
Mandible +24.13 -0.20 0.177 1.370 NS
Arch length and dentoalveolar disproportion
Maxilla -26.11 +0.87 0.590 5.569$
Mandible -26.67 +0.96 0.555 5.087.t
Mean intermolar width and dentoalveolar disproportion
Maxilla - 23.68 +0.69 0.513 4.550t
Mandible -31.41 +0.85 0.550 5.015t
Interincisal width and dentoalveolar disproportion
Maxilla - 19.28 +0.98 0.514 4.56Ot
Mandible - 19.20 +0.96 0.493 4.319t
Arch perimeter and dentoalveolar disproportion
Maxilla -51.78 +0.57 0.742 8.432$
Mandible -49.80 +0.58 0.702 7.512$

*Denotes correlation coefficient.


tsignificant at P < 0.01.
$Significant at P < 0.001.

Table IV. Correlations among cumulative crown widths, arch dimensions, and dentoalveolar disproportion
in the Pakistani immigrant group
Correlation under test Intercept A (mm) Gradient B r* t value

Cumulative crown widths and dentoalveolar disproportion


Maxilla +7.91 -0.01 0.006 0.043 NS
Mandible + 3.96 +0.01 0.013 0.098 NS
Arch length and dentoalveolar disproportion
Maxilla - 25.59 +0.83 0.634 6.240$
Mandible - 11.70 +0.49 0.404 3.365t
Mean intermolar width and dentoalveolar disproportion
Maxilla - 20.86 +0.63 0.358 2.921 t
Mandible -3.85 +0.20 0.164 1.269 NS
Interincisal width and dentoalveolar disproportion
Maxilla -5.63 +0.46 0.246 1.930 NS
Mandible -6.31 +0.52 0.277 2.194 NS
Arch perimeter and dentoalveolar disproportion
Maxilla -44.94 +0.50 0.703 7.538$
Mandible -27.22 +0.34 0.588 5.541$

*Denotes correlation coefficient.


t Significant at P < 0.01.
$Significant at P < 0.001.

ious parameters and dentoalveolar disproportion, a step- sults for each ethnic group are shown in Tables V
wise multiple regression analysis was applied to the and VI. In both ethnic groups, the multiple correlation
data. A five-step regression procedure was used with coefficients were highly significant for maxillary and
automatic sequential deletion of the least significant mandibular arches. The partial regression coefficients
variables. Dentoalveolar disproportion was designated were significant (P < 0.01) for two predictors in the
the dependent variable; cumulative mesiodistal crown first step of the regression-namely, cumulative me-
widths, arch widths, arch length, and arch perimeter siodistal crown widths and arch perimeter. This is in
were the independent variables or predictors. The re- accord with the method of calculating dentoalveolar
Volume 94
Dental crowding !i!i
Number 1

Table V. Stepwise multiple regression analysis Table VI. Stepwise multiple regression analysis
applied to the indigenous British group data applied to the Pakistani immigrant group data
Partial
Lndepe;e;;iable m Independent variable regression
(predictor) coefjcient F ratio

Maxilla (Multiple correlation coey‘jicient = 1) (N = 60*) Maxilla (Multiple correlation coejj‘icient = I) (N = 60*)
Cumulative mesiodistal crown 0.986 617.8t Cumulative mesiodistal crown - 0.999 472.4t
widths widths
Interincisal width 0.005 0.001 NS Interincisal width 0.066 0.202 NS
Mean intermolar width 0.007 0.000 NS Mean intermolar width 0.048 0.129 NS
Arch length 0.001 0.000 NS Arch length 0.054 0.159 NS
Arch perimerer - l.ooo 22181t Arch perimeter 0.998 20435t
Mandible (Multiple correlation coeficient = I) (N = 60*) Mandible (Multiple correlntion coeficient = 1) (N = 60*)
Cumulative mesiodistal crown - 0.999 409.8t Cumulative mesiodistal crown 0.979 120.2t
widths widths
Interincisal width - 0.078 0.328 NS Interincisal width 0.001 0.001 NS
Mean intermolar width 0.291 5.012 NS Mean intermolar width 0.001 0.001 NS
Arch length -0.010 0.012 NS Arch length 0.001 0.000 NS
Arch perimcer 0.999 12941.f Arch perimeter - l.ooo 998831-

Dependent variable is dentoalveolar disproportion. Dependent variable is dentoalveolar disproportion.


*Denotes sample size used in the regression analysis *Denotes sample size used in the regression analysis.
t Significant at P < 0.01. t Significant at P < 0.01.

disproportion in the present study. Partial regression able arch perimeter. The partial regression coefficients
coefficients for interincisal arch width, intermolar arch for predictors arch length and mean intermolar arch
width, and arch length were not statistically significant width now became more significant (P < 0.01) than
(P < 0.01) in either ethnic group. The order of elim- the partial regression coefficient for cumulative me-
ination of predictors in the analysis was as follows: arch siodistal crown widths. This was supported also by the
length, interincisal arch width, mean intermolar arch correlation coefficients (Tables III and IV) obtained
width, and cumulative mesiodistal crown width. from the computed correlation matrix.
Random and systematic errors occurring between The most important findings of the present inves-
repeated measurements were determined as part of a tigation were as follows:
larger investigation, but did not reach levels of statis- 1. Significant correlations were present between
tical significance (at P < 0.01). various arch dimensions and dentoalveolar dis-
proportion in both ethnic groups. Arch length
DISCUSSIOIY and arch perimeter in particular showed a sig-
It would #appearfrom the analysis that the variables, nificant correlation even at P < 0.001.
as considered collectively, contribute very significantly 2. The correlation coefficients for cumulative me-
to the variations in dentoalveolar disproportion. Of the siodistal crown widths were of a low order, sug-
individual predictor variables, initially only cumulative gesting no significant correlation between cu-
mesiodistal crown widths and, in particular, arch pe- mulative mesiodistal crown widths and dentoal-
rimeter appeared to contribute significantly to the ef- veolar disproportion in either ethnic group when
fectiveness of the overall regression. This was ob- considered in isolation. However, in combina-
viously to be expected since dentoalveolar dispropor- tion with the other parameters, cumulative me-
tion was calculated as the numerical difference between siodistal crown widths appeared to make a sig-
cumulative rnesiodistal crown widths and arch perim- nificant contribution to dentoalveolar dispropor-
eter. However, the partial regression coefficient for arch tion in the overall regression equation. This
perimeter (a predictor variable) was so highly signifi- suggests a complex interrelationship between the
cant that the relative effectiveness of the predictor vari- various parameters and dentoalveolar dispro-
ables of interincisal arch width, intermolar arch width, portion.
and arch len,gth was rendered insignificant. This view The significant correlations found among arch
was supported when a further regression analysis was length, arch perimeter (and, to a lesser extent, arch
carried out with forced elimination of the predictor vari- width), and crowding or spacing support the findings
56 Radnzic Am. J. Orthod. Dentofac. Orthop.
July 1988

of Mills,’ McKeown,” and Howe, McNamara, and I am most grateful to Mr. J. F. Gravely, Senior Lecturer
O’Connor.‘3 They do not support the findings of Fast- in Orthodontics, University of Leeds Dental Hospital, for his
licht,’ Norderval, Wisth, and B6e,” or Doris, Bernard, advice and guidance during the investigation, and also to Mr.
and Kuftinec.” This would seem to suggest that arch A. J. Doyle, District Dental Officer, RochdaleDistrict Health
size is more important than tooth size as a cause of Authority, for provision of materials and facilities.
crowding. However, all the parameters appear to be REFERENCES
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relapse. Therefore, in the majority of cases, carefully 93 Leander Drive
planned extractions will continue to be an important Castleton
part of treatment in the relief of primary dental Rochdale, Lancashire
crowding. England OLl 1 2XD