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ORIGINAL ARTICLE

Evaluation of dental arch width and form changes after orthodontic treatment and retention with a new computerized method
Tulin (Ugur) Taner, DDS, PhD,a Semra Ciger, DDS, PhD,b Hakan El, DDS,c Derya Germec, DDS,c and Alphan Esd Ankara, Turkey The purpose of this study was to evaluate longitudinal arch width and form changes and to dene arch form types with a new computerized method. Maxillary and mandibular models of 21 Class II Division 1 patients were examined before treatment (T0), after treatment (T1), and an average of 3 years after retention (T2). Arch width measurements were made directly on scanned images of maxillary and mandibular models. Arch form changes at T0-T1 and T1-T2 were evaluated by superimposing the computer-generated Bezier arch curves with a computer program. Types of dental arch forms were dened by superimposing them with the pentamorphic arch system, which included 5 different types of arch forms: normal, ovoid, tapered, narrow ovoid, and narrow tapered. Maxillary arch widths were increased during orthodontic treatment. Mandibular posterior arch widths were also increased. The expansion of the mandibular arch forms was less than in the maxillary arch forms. Arch width changes were generally stable, except for reduction in maxillary and mandibular interlateral, inter-rst premolar, and mandibular intercanine widths. Pretreatment maxillary arch forms were mostly tapered; mandibular arch forms were tapered and narrow tapered. In maxillary arch forms, 76% of the treatment changes were maintained. Mandibular arch form was maintained in 67% of the sample, both during treatment and after retention. In mandibular arches, 71% of orthodontically induced arch form changes were maintained. (Am J Orthod Dentofacial Orthop 2004;126:464-76)

ental arch width and form are important factors for determining the success and stability of orthodontic treatment. Arch shape affects both the functional and the esthetics of the occlusion. Preservation of dental arch shape during growth is an indicator of the equilibrium of teeth between tongue and circumoral muscle forces.1 Dimensional changes of dental arches might affect arch form as well. Arch width changes during growth and after orthodontic therapy have been examined in various studies.2-9 A general tendency toward an increase in intermolar width was noted during the change from deciduous to permanent dentition.2 This expansion is generally accompanied by a decrease in arch depth.10,11 In arch-form studies, attempts have been made to dene an ideal arch shape,11-13 but considerable indiAssociate professor, Department of Orthodontics, University of Hacettepe, Ankara, Turkey. b Professor and chair, Department of Orthodontics, University of Hacettepe. c Research assistant, Department of Orthodontics, University of Hacettepe. d Senior researcher, Bilten, Ankara, Turkey. Reprint requests to: Dr Tulin (Ugur) Taner, University of Hacettepe, Faculty of Dentistry, Department of Orthodontics, Ankara 06100, Turkey; e-mail, tulinortho@hotmail.com. Submitted, November 2002; revised and accepted, August 2003. 0889-5406/$30.00 Copyright 2004 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2003.08.033
a

vidual variability existed. Studies of untreated subjects showed a pentamorphic arch system, which included 5 different types of arch form: normal, ovoid, tapered, narrow ovoid, and narrow tapered.14 Various methods have been used to dene these arch forms mathematically, including geometric curves, such as ellipses,1,15,16 parabolas,17 catenary curves,18,19 and equations, such as polynomial functions,13,17,20 cubic splines,21,22 conic sections,23 -functions,20,24,25 and the Bezier cubic equation.26 The Bezier cubic equation was rst developed by the French engineer Pierre Bezier for use in designing Renault automobile bodies. Bezier splines have several properties that make them highly useful and convenient for curve and surface design. In general, a Bezier curve section can be tted to any number of control points. The number of control points to be approximated and their relative position determine the degree of the Bezier polynomial. For these reasons, Bezier splines are widely available in various computer-aided design and computer-aided manufacturing systems, in general graphics packages, and in assorted drawing and painting packages.27 In orthodontics, the Bezier curve was rst used to dene arch forms in a sample of untreated normal occlusions and cases of maxillary constriction.26 In that

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study, maxillary and mandibular dental arch casts of 25 subjects with normal occlusions and 19 subjects with maxillary constrictions were used to compare the intertooth dimensions on manual tracings on scanned images of the casts and on computer program printouts of Bezier arch curves. The Bezier arch curves have been found to follow the initial and end points of the arch curve perfectly. The correlations between the traditional intertooth dimensions and the Bezier spline method were found to be high in the posterior region of the dental arch and moderate in the canine and lateral incisor area. Few studies have been conducted to evaluate longitudinal dental arch form changes in orthodontically treated subjects. The commonly held view has been that the original arch form should be maintained to ensure stability. However, in certain patients, arch form is purposely changed with orthodontic treatment. In Class II Division 1 patients, the maxillary arch form is usually expanded to accommodate the mandibular arch.23,28,29 In this study, the Bezier cubic equation was used to assess orthodontic relapse in orthodontically treated Class II Division 1 patients. The method of quantifying the arch form with Bezier curves was found to be valid: the correlations between traditional intertooth dimensions and Bezier variables were high and moderate in the posterior and anterior parts of the dental arch, respectively.26 The results of 2 other orthodontic relapse studies showed moderate correlations with conic and cubic spline variables.23,28 The purposes of this study were (1) to evaluate with a computerized method the maxillary and mandibular dental arch width and form changes during nonextraction orthodontic treatment and after a mean postretention time of 3 years in Class II Division 1 patients, (2) to examine the associations between intertooth dimensions and arch form, and (3) to dene the changes in maxillary and mandibular arch form types according to the pentamophic arch system.
MATERIAL AND METHODS

1.6 years (range, 10 to 14 years). Mean treatment time was 3 1.4 years, followed by a mean retention time of 1 0.6 years with maxillary and mandibular Hawley appliances. Mean postretention time was 3 1.4 years. Measurements were made on the patients maxillary and mandibular dental casts before treatment (T0), after treatment (T1), and after retention (T2).
Cast evaluation

Maxillary and mandibular dental casts of 21 Class II Division 1 patients were assessed for changes in arch width and form during orthodontic treatment and after retention. All patients received nonextraction treatment combined with headgear. Patients were included in the study if (1) a clinically acceptable occlusion was established after active treatment, and (2) they received no palatal expansion, orthognathic surgery, or xed prosthodontic therapy. The mean ( standard deviation) age of the patients at the beginning of orthodontic treatment was 11.7

On the maxillary and mandibular dental casts, the following landmarks were marked with a black 0.3mm-thick pencil: the midpoint of the incisal edges of the central incisors; the midpoint of the incisal edges of the lateral incisors; buccal cusp tips of the canines; buccal cusp tips of the rst premolars; buccal cusp tips of the second premolars; and mesiobuccal cusp tips of the rst molars. In cases of wear, the estimated point of cusp tips or midincisal points were used. A point halfway between the adjacent teeth represented the unerupted teeth. In the presence of deciduous teeth, the midpoint of the buccal mesiodistal distance of the molars and the cusp tip of the canines were marked. After marking the landmarks, the casts were scanned with a Umax 1200 Astra scanner (Umax Systems, Willich, Germany). All casts were placed in the same x and y coordinates according to a template for standardization. Then each landmark on the scanned images of the casts at the 3 time points was digitized with a new computer program developed for this study (Dental Model Planner; Bilten, Ankara, Turkey). This program allowed us to scan images of the dental casts with no magnication error. Images were scanned at a resolution of 150 dots per inch (dpi). The resolution of the scan can also be expressed as Rscan inch (Rscan in), which in this study is 150 dpi. Thus, the size of a single pixel (Spixel) was 1/150 in. When the image is not magnied, the scale factor (Sfactor) was 1, and each image pixel seen on the screen was also 1/Rscan in (1/150 dpi). The fscale could be increased to zoom in and decreased to zoom out. If fscale was increased to 2 times, each scanned image pixel would cover twice the area in the display, and thus the image was displayed twice the size. The actual size of a displayed image pixel in inches is inversely proportional to the fscale (1/fscale). Ultimately, the size of a scaled image pixel in inches was calculated with the following formula: Spixel (1/fscale) (1/Rscan). With this fomula, the coordinates of the dened points in image space and the Euclidian distance between them were also calculated accurately.

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crosoft, Redmond, Wash) to synchronize to current operating systems and hardware, and a computergenerated Bezier arch form was made for each dental cast. Four points dene a cubic Bezier curve. There are 2 end points: (x0, y0) is the origin end point, and (x3, y3) is the destination end point. The other points (x1, y1) and (x2, y2), are control points. Two equations dene the points on the curve. Both are evaluated for an arbitrary number of values of t between 0 and 1. One equation yields values for x; the other yields values for y. As increasing values for t are supplied to the equations, the point dened by x(t), y(t) moves from the origin to the destination. This is how the equations are dened: x t a xt 3 b xt 2 c xt x 0
Fig 1. Determination of dental arch dimensions.

x1 x2

x0 x1 x0 a yt 3 y0 y1 y0

c x/3 cx cx b x /3 bx ax c yt y0

Dental arch measurements

After digitizing the anatomic landmarks, the program output the following dental arch dimensions for maxillary and mandibular dental casts (Fig 1): Intercentral width (right central-left central [R1-L1]): the distance between the midincisal points of the central incisors Interlateral width (right lateral-left lateral [R2-L2]): the distance between the midincisal points of the lateral incisors Intercanine width (right canine-left canine [R3-L3]): the distance between the buccal cusp tip points of the left and right canines Interrst premolar width (right rst premolar-left rst premolar [R4-L4]): the distance between the buccal cusp tip points of the left and right rst premolars Intersecond premolar width (right second premolar-left second premolar [R5-L5]): the distance between the buccal cusp tip points of the left and right second premolars Intermolar width (right rst molar-left rst molar [R6L6]): the distance between the mesiobuccal cusp tip points of the left and right rst permanent molars Arch depth (AD): the length of the perpendicular from the midpoint of the intercentral width to the intermolar distance
Determination of arch form

x3 y t y1 y2 y3

b yt 2 c y/3 cy cy

b y /3 by ay

The Bezier cubic spline function was used to develop the computer program written previously26 with Borland Turbo Pascal (Borland Software, Scotts Valley, Calif) programming language. This program was rewritten with Microsoft Visual C 6.0 (Mi-

The variation in arch form at T0-T1 and T1-T2 was evaluated by superimposing the computer-generated arch curves with the Photoshop software program (Adobe Systems, San Jose, Calif) (Fig 2). Intercentral width was used for registration during superimposition of the scanned images of the models because this distance remained relatively stable in maxillary and mandibular models in all time periods. After superimposition, these images were magnied to 170%, printed, and the areas between the Bezier arch curves were measured with a software program especially developed for this purpose. A line was drawn between the canine cusp tips to separate anterior and posterior areas, and then various points were digitized, forming the area to be measured. Because the scanning resolution of 150 dpi was chosen in this study, the length of a Spixel was 1/150 in; thus the area of a Spixel was (1/150) (1/150) in2 or (1/150)2 in2. When the number of pixels in a closed area is 1000, the area in inches is 1000 (1/150)2 in2. In a magnied image, the pixel size is (100/m) (1/150) in, where m is the magnication rate. To correct the magnication change in this study, the following formula was used: Spixel area (in2) [(100/170) (1/150)]2. Because we used metric

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Dahlbergs formula

d2 . The measurement 2n errors between the rst and second computerized measurements were less than 0.5 mm. Similarly, measurement errors between the computerized and manual measurements were less than 0.5 mm for all calculations. ME

RESULTS

Fig 2. Arch form change was evaluated by measuring areas between 2 arch curves when superimposed at intercentral width. Anterior and posterior areas were measured separately by drawing perpendicular lines from cusp tip of canines to arch form. These lines divided whole area into 3 segments (2 posterior and 1 anterior).

units, inches squared is then converted to millimeters squared. After the anterior and the posterior areas were digitized separately, the area was calculated both in pixels and in millimeters squared with a customdeveloped program. Types of dental arch form were assessed by superimposing the computer-generated Bezier arch curves on the pentamorphic arch template (Fig 3). The best-t method was used when dental midlines of computergenerated and pentamorphic arches were superimposed. One operator assessed the arch form change at 2 different times. The subjective evaluation of the operator revealed no intraexaminer variability. Of the computer-generated arch forms, 35% t exactly with 1 of the pentamorphic arch forms dened as normal, ovoid, tapered, and narrow tapered. In 65%, anterior curves t and posterior arch forms were wider than the pentamorphic arches.
Statistical analysis

The Wilcoxon test was used to compare the arch width changes at T0, T1, and T2 time intervals. Spearman correlation tests were used to evaluate the association between maxillary and mandibular arch width and area changes. To assess method error, 10 maxillary and 10 mandibular randomly chosen casts were redigitized and manually remeasured. The differences between the double measurements were calculated according to

Table I shows the comparison of the maxillary arch width changes during treatment (T1-T0) and the postretention period (T2-T1). The distances between all maxillary teeth increased signicantly during orthodontic treatment, except for the intercentral width. The greatest increase was between the rst premolars, with a mean value of 4.33 1.91 mm (P .001). This was followed by the second premolar width, with a mean value of 3.95 2.36 mm (P .001). A signicant decrease in arch depth was also found during orthodontic treatment (mean 1.30 2.61 mm, P .05). During the postretention period, signicant decreases were found in interlateral and inter-rst premolar tooth widths, with mean values of 0.66 1.23 mm (P .05) and 0.91 1.45 (P .01), respectively. The rest of the maxillary arch and arch depth remained stable. A comparison of the mandibular arch width changes at the 3 time periods is shown in Table II. Signicant increases in interpremolar and intermolar widths occurred during orthodontic treatment. The greatest increase was found in the intermolar distance, with a mean value of 2.31 2.71 mm (P .01), followed by the second and rst interpremolar widths (P .01). At the postretention stage, interlateral, intercanine, and interpremolar widths decreased significantly (P .01 and P .05, respectively). A signicant decrease in arch depth was also found (mean 1.08 1.39 mm, P .01). The mean maxillary anterior area was increased during treatment. Maxillary posterior area was increased even more, and this increase was highly correlated with the inter-second premolar width (r 0.81, P .001) and moderately correlated with the inter-rst premolar width (r 0.61, P .01) and arch depth (r 0.67, P .05). At the postretention period, the maxillary arch form did not show much change (Table III). Mandibular anterior area changes during orthodontic treatment were much smaller and more variable compared with the maxillary arch during orthodontic treatment. Mandibular posterior area was increased with treatment, and this increase was moderately highly correlated with the intermolar width (r 0.71, P

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Fig 3. Determination of arch form type by superimposition of pentamorphic arch template on computer-generated arch curves.
Table I.

Comparison of maxillary arch width changes (n


Mean time standard deviation T1 0.83 1.74 1.87 1.44 1.96 2.88 3.05 .001. 8.82 23.96 34.90 43.37 48.47 52.28 28.98 0.51 1.10 1.71 1.63 2.22 2.46 2.22 T2 8.79 23.30 34.69 42.46 48.16 52.90 28.49 0.60 1.03 1.55 1.62 2.11 2.47 2.14

21)
Mean time difference T1-T0 0.03 1.14 2.53 4.33 3.95 3.34 1.30 0.66 1.83* 2.00*** 1.91*** 2.36*** 3.06*** 2.61* standard deviation T2-T0 0.06 0.48 2.31 3.41 3.64 3.96 1.79 0.62 1.54 1.63*** 1.34*** 1.92*** 2.53*** 2.12**

Distances (mm) R1-L1 R2-L2 R3-L3 R4-L4 R5-L5 R6-L6 Arch depth *P .05; **P

T0 8.85 22.82 32.38 39.04 44.52 48.93 30.28 .01; ***P

T2-T1 0.03 0.66 0.22 0.91 0.31 0.62 0.49 0.41 1.23* 1.05 1.45** 1.16 1.54 1.57

.001) and moderately correlated with the inter-second premolar width (r 0.53, P .05), inter-rst premolar width (r 0.50, P .05), and arch depth (r 0.56, P .01). For the postretention period, mandibular arch form did not show much change (Table III). According to the superimpositions with the pentamorphic arch system, 62% (13 of 21) of the maxillary arches were tapered, 24% (5 of 21) were normal, and 14% (3 of 21) were narrow tapered at the beginning of orthodontic treatment. During orthodontic treatment,

tapered maxillary arch forms were changed to ovoid and normal arch forms at rates of 62% (8 of 13) and 31% (4 of 13), respectively. Of the pretreatment normal maxillary arch forms, 40% (2 of 5) were changed to an ovoid dental arch form. All narrow tapered arch forms were changed to normal during treatment (Table IV). At the postretention period, 76% (13 of 17) of the treatment changes in maxillary arch form remained stable (Table V). Of the mandibular arch forms, 43% (9 of 21) were

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Table II.

Comparison of mandibular arch width changes (n


Mean time standard deviation T1 0.58 1.50 1.91 2.01 2.06 2.42 2.33 .001. 5.52 16.75 26.49 35.52 41.39 45.87 25.10 0.31 0.83 1.40 1.64 1.97 2.48 1.83 T2 5.39 16.05 25.87 34.77 40.73 45.88 24.01 0.37 1.11 1.39 1.15 2.25 2.44 1.83

21)
Mean time difference T1-T0 0.25 0.21 0.06 1.98 2.15 2.31 0.04 0.62 1.27 1.76 2.53** 2.32** 2.71** 1.82 standard deviation T2-T0 0.38 0.90 0.56 1.22 1.49 2.31 1.05 0.69* 1.11** 1.45 1.70** 2.21* 2.54** 1.69*

Distances (mm) R1-L1 R2-L2 R3-L3 R4-L4 R5-L5 R6-L6 Arch depth *P .05; **P

T0 5.77 16.95 26.43 33.55 39.24 43.56 25.06 .01; ***P

T2-T1 0.13 0.69 0.62 0.75 0.66 0.01 1.08 0.31 0.81** 0.93** 1.36* 1.38* 1.24 1.39**

Table III. Maxillary and mandibular arch size changes at T1-T0 and T2-T1 Area (mm2) Maxillary anterior area Maxillary posterior area Mandibular anterior area Mandibular posterior area Time span T1-T0 T2-T1 T1-T0 T2-T1 T1-T0 T2-T1 T1-T0 T2-T1 Mean 169.26 6.97 414.08 26.07 10.93 3.46 145.76 26.88 SD 154.11 40.27 279.83 108.61 31.67 43.98 171.60 101.73

and remained normal during treatment and at postretention. Case 2 (Fig 5) is an example of dental arch form relapse. The maxillary and mandibular arches were expanded during treatment. At the postretention stage, maxillary and mandibular arches relapsed. The maxillary arch was tapered before treatment, changed to ovoid with treatment, and became normal at the postretention. The mandibular arch form was narrow tapered before treatment, changed to normal with treatment, and relapsed to a tapered dental arch form at postretention.
DISCUSSION

tapered, 43% (9 of 21) were narrow tapered, and 14% (3 of 21) were normal at the beginning of orthodontic treatment. During treatment, 67% (6 of 9) of the pretreatment tapered arch forms remained tapered, 22% (2 of 9) were changed to normal, and 11% (1 of 9) was changed to narrow tapered. Pretreatment normal mandibular arch forms were not changed. Narrow tapered arch forms mostly remained narrow tapered (56%, 5 of 9) (Table VI). At the postretention stage, 71% (5 of 7) of the treatment changes in mandibular arch forms were maintained (Table VII). Of pretreatment mandibular arch forms that were not altered during orthodontic treatment, 36% (5 of 14) changed their form at the postretention period (Table VIII).
Case examples

The following cases are examples of stability and relapse after orthodontic treatment. Case 1 (Fig 4) is an example of stability in the maxillary dental arch form. A large increase in the maxillary anterior and posterior areas occurred during treatment. A slight mandibular posterior expansion was also obtained. At the postretention stage, all changes remained stable. The maxillary arch form was tapered before treatment, changed to ovoid with treatment, and remained ovoid at postretention. The mandibular arch form was normal before treatment

Computer programs for diagnostic purposes can provide accurate data for researchers and help to dene complex arch form patterns easily. It is also possible to describe an arch form specic to each patient with the ongoing development of computerassisted analysis. In this study, a new computer program was designed to evaluate arch width and form changes. Regarding our method error, it can be seen that manual and computerized intra- and interobserver measurements were similar. Arch forms were generated with Bezier curves based on the Bezier cubic spline function. The accuracy of Bezier curves in reecting arch form was found to be strong in the posterior and moderate in the anterior parts of the dental arch.26 Relapse studies with a cubic spline function and conic sections also showed moderate correlations between generated arch forms and traditional intertooth dimensions.23,28 The major difference between the Bezier arch curves and arch forms generated with cubic splines and conic sections was that the Bezier arch form passed palatal to the incisors because of the nature of the curve. However, this did not affect our results because all arch forms were generated the same way to examine the changes during treatment and at postretention.

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Table IV.

Maxillary arch form changes during treatment (n

21)
T1

T0 Tapered (n 13, 62%) Ovoid (n 0, 0%) Normal (n 5, 24%) Narrow tapered (n 3, 14%) *Total unchanged (n Table V. 4/21, 19%).

(n

Tapered 1, 4%) 1 (7%)*

(n

Ovoid 10, 48%) 8 (62%) 2 (40%)

(n

Normal 10, 48%) 4 (31%) 3 (60%)* 3 (100%)

Narrow tapered (n 0, 0%)

Postretention changes in maxillary arch form altered by treatment (n


T2

17)

T1 Tapered (n 0, 0%) Ovoid (n 10, 59%) Normal (n 7, 51%) Narrow tapered (n 0) *Total unchanged (n Table VI. 13/17, 76%).

(n

Tapered 1, 6%)

(n

Ovoid 9, 53%)

(n

Normal 7, 41%)

Narrow tapered (n 0, 0%)

1 (14%)

8 (80%)* 1 (14%)

2 (20%) 5 (72%)*

Mandibular arch form changes during treatment (n

21)
T1

T0 Tapered (n 9, 43%) Ovoid (n 0, 0%) Normal (n 3, 14%) Narrow tapered (n 9, 43%) *Total unchanged (n 14/21, 67%).

(n

Tapered 8, 38%) 6 (67%)*

(n

Ovoid 0, 0%)

(n

Normal 7, 33%)

Narrow tapered (n 6, 29%) 1 (11%)

2 (22%) 3 (100%)* 2 (22%)

2 (22%)

5 (56%)*

This study was designed to evaluate dental arch width and form changes during nonextraction orthodontic treatment and after postretention in Class II Division 1 patients. It is a commonly held view that minimal changes in arch form would produce minimal postretention changes. However, in certain patients, the arch form had to be changed to achieve the goals of orthodontic treatment. In Class II patients with a tapered maxillary arch form and ared incisors, the maxillary arch is frequently expanded to accommodate the mandibular arch during the anteroposterior correction of the jaw relationship.
Treatment changes

Maxillary intertooth widths were signicantly increased during orthodontic treatment. Maxillary arch expansion is usually expected in the correction of Class II patients in whom anteroposterior movement was

likely to have occurred, and many investigators have noted maxillary expansion after Class II correction.10,23,29 However, it was not possible to differentiate the treatment effects from natural growth in young patients because signicant maxillary arch width growth between the ages of 7 and 12 years has been reported.4 Mandibular posterior intertooth widths were also increased but to a lesser extent compared with the maxilla. BeGole et al30 also found lesser expansion in the mandible compared with the maxilla in nonextraction-treated patients. An explanation of this variation might be the different treatment needs and different growth in arch widths between the maxilla and the mandible. Less growth occurs in mandibular transverse dimensions compared with the maxillary arch in young children.3 The greatest maxillary arch width gain was between

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Table VII.

Postretention changes in mandibular arch form altered by treatment (n


T2

7)

T1 Tapered (n 2, 29%) Ovoid (n 0, 0%) Normal (n 4, 57%) Narrow tapered (n 1, 14%) *Total unchanged (n 5/7, 71%).

(n

Tapered 4, 57%)

Ovoid (n 0)

(n

Normal 2, 29%)

Narrow tapered (n 1, 14%)

2 (100%)* 2 (50%) 2 (50%)* 1 (100%)*

Table VIII.

Postretention changes in mandibular arch form maintained during treatment (n


T2

14)

T1 Tapered (n 6, 43%) Ovoid (n 0, 0%) Normal (n 3, 21%) Narrow tapered (n 5, 36%) *Total unchanged (n 9/14, 64%).

(n

Tapered 7, 50%) 4 (67%)* 1 (33%) 2 (40%)

Ovoid (n 0)

(n

Normal 4, 29%) 2 (33%) 2 (67%)*

Narrow tapered (n 3, 21%)

3 (60%)*

the rst premolars, followed in descending order by the second premolars, the molars, and the canines. BeGole et al30 reported similar ndings, although the intersecond premolar width showed the greatest arch width gain in their sample. This difference might be due to different treatment needs. The greatest arch width increase in the mandible was between the rst molars, followed by the second and rst premolars. This agrees with the ndings of BeGole et al,30 who found expansions in the same order. Increase in maxillary and mandibular posterior areas showed posterior expansion in maxillary and mandibular arches. However, standard deviations of the mean values were high and showed considerable individual variability. De La Cruz et al23 also addressed a high degree of individual variability when evaluating arch form relapse in Class I and Class II patients treated with 4 premolar extractions. In this study, signicant correlations were found between the area changes and the intertooth dimensions. The posterior area expansion was correlated with the increase in interpremolar and intermolar widths and decrease in arch depths. Arch depth decrease in association with posterior expansion of the dental arch might be due to the geometric structure of the maxillary arch. It has been demonstrated that every 3 mm of posterior maxillary expansion results in a 1-mm reduction of arch depth.10 Maxillary arch forms were mostly tapered before treatment and changed to ovoid or normal arch forms during treatment. Pretreatment normal arch forms were

changed to ovoid, and narrow tapered arch forms were changed to normal. During orthodontic treatment 81% (17 of 21) of the sample had their maxillary arch forms changed. De La Cruz et al23 also stated that maxillary arch forms were more tapered at the beginning of orthodontic treatment in an extraction Class II sample and became more rounded during treatment. Mandibular arch forms were mostly tapered and narrow tapered before treatment. Tapered arch forms kept their original shapes or changed to normal or narrow tapered during orthodontic treatment. Pretreatment narrow tapered mandibular arch forms remained mostly narrow tapered or changed to normal or tapered arch forms. Pretreatment normal mandibular arch forms were not changed with treatment. Overall, 33% (7 of 21) of our sample had their mandibular arch forms changed during treatment. Felton et al12 stated that 70% (21 of 30) of their Class II sample had their arch forms changed during orthodontic treatment. The difference between studies might be due to different treatment needs and growth changes.
Postretention changes

The treatment-induced changes in maxillary and mandibular intertooth dimensions were signicantly stable in this study, except for decreases in interlateral and inter-rst premolar tooth widths. Maxillary arch width stability in Class II nonextraction-treated patients has been reported by many investigators.8,9,30,31 Mandibular intermolar width has also been reported to be

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Fig 4. Pretreatment (T0, black), posttreatment (T1, dark grey), and postretention (T2, light grey) maxillary and mandibular arches in patient with stable arch form. Data shown are age in years, arch form change, measured as anterior and posterior areas, and change in arch form type.

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Fig 5. Pretreatment (T0, black), posttreatment (T1, dark grey), and postretention (T2, light grey) maxillary and mandibular arches in patient with arch form relapse. Data shown are age in years, arch form change, measured as anterior and posterior areas, and change in arch form type.

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relatively stable.5,7,12,31,32 On average, postretention maxillary arch form evaluation also showed expansion. The decrease in interlateral tooth width might indicate an increase in postretention crowding, but the amount of incisor irregularity was not evaluated in this study. In the mandible, a signicant reduction in intercanine width was found in this study, although it was maintained during treatment. It is a common nding that mandibular intercanine width tends to return to its original dimension, especially when it has been increased during orthodontic treatment.5,9,12,32,33 However, in another study, a reduction in intercanine width was found despite the minimal treatment change.7 The results of this study support the idea that maintenance of intercanine width does not guarantee postretention stability.34,35 A signicant decrease in mandibular interlateral distance was also found. Mandibular anterior area also showed an average decrease, in accordance with the reduction in interlateral width. This might be due to an increase in mandibular anterior irregularity, but the implications for changes and stability in arch form in relation to incisor irregularity were not considered in this study. Mandibular inter-rst premolar tooth width also decreased signicantly, in accordance with the constriction in the maxillary rst premolar area. A slight constriction in the mandibular second premolar area was also found. Hence, the reduction in mandibular arch depth cannot be attributed to posterior mandibular expansion; rather, arch length decrease might have played a role in this reduction. Maxillary arch form types remained highly stable in this study. In 76% (13 of 17) of the sample, maxillary arch form changes were maintained. Davis and BeGole28 also reported a lesser but still high stability value of 65% for maxillary arch forms in nonextraction-treated patients. In the mandibular arches of this study, 71% (5 of 7) of the treatment change remained stable at the postretention period. In contrast, other investigators reported 30%-34% stability for the mandibular arch form.12,28 It is hard to explain this difference by making direct comparisons between studies. Only 1 study evaluated the dental arch form relapse in nonextraction-treated Class II Division 1 patients, as in this study.12 However, no mention was made regarding the growth potential of the patients making up their study sample or the quantication of arch form change in their study. Other studies evaluated arch form changes in an extraction-treated Class II Division 1 sample and a mixed nonextraction-treated group of patients.23,28 Our ndings suggest that stability might not be related to the amount of change during orthodontic

treatment. Sixty-seven percent (14 of 21) of mandibular arch forms in this study were not changed during treatment, although 36% (5 of 14) of them changed their form at postretention. Growth might be responsible for postretention changes in mandibular arch forms that were not altered during orthodontic treatment. Regarding our method, a certain degree of subjectivity was unavoidable in the evaluation of the best t of a pentamorphic arch type on computer-generated Bezier curves. Nevertheless, intraexaminer reliability was carefully evaluated, and it supports the reproducibility of our technique. However, the small number of patients with some arch form types in this study should be kept in mind when evaluating the ndings. Arch form studies with larger sample sizes are needed to explain the high variability in dental arch form stability. A new study is being undertaken in our clinic with a larger sample size and with other mathematical functions to evaluate the longitudinal dental arch form changes.
CONCLUSIONS

1. During nonextraction orthodontic treatment of Class II Division 1 patients, all widths but the intercentral were increased, and the maxillary arch form was expanded anteriorly and posteriorly. Mandibular posterior arch widths were also increased, but the expansion of mandibular arch form was less than that in the maxilla. 2. Arch width changes were generally stable, except the reduction in maxillary and mandibular interlateral, inter-rst premolar, and mandibular intercanine widths. 3. Maxillary arch forms were mostly tapered before treatment. During treatment, 81% of the sample had their maxillary arch forms changed. At the postretention evaluation, 76% of the treatment changes remained stable. 4. Most of the mandibular arch form types were tapered and narrow tapered before treatment. At the end of treatment, 33% of the mandibular arch forms were changed, and, at the postretention evaluation, 71% of them showed stability. We are indebted to Prof Dr Aksoy, whose studies were guidelines in preparing this research project, and we mourn his premature death in the earthquake of August 17, 1999.
REFERENCES 1. Brader AC. Dental arch form related to intraoral forces: PR C. Am J Orthod 1972;61:541-61. 2. Moores CFA, Gron AM, Lebret LM, Yen PK, Fronlich FJ.

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COMMENTARY

Retention and stability of treatment results is a major concern in orthodontics. As Oppenheim1 once said, retention is the most difcult problem in orthodontia; in fact, it is the problem. The use of computer software and mathematics to evaluate stability is taking the place of subjective judgments in contemporary orthodontics, and this is the most important positive point in this research. From a methodologic point of view, this study sounds good, and the authors have also provided clear gures and examples. Despite the strength of the research, some limitations must be considered. When the Bezier curve is tted to a group of points, it passes only from the rst and last points, and, as the authors have stated, it passes palatal to the incisors; this is the major shortcoming of this function. Better mathematic functions are available for this purpose, and it is good news that the authors are using other functions for a similar study. The sample size is small, and it is divided into 5 subgroups; thus, arch form changes in the subgroups should be interpreted with caution. It is nice to hear that a similar study is being performed on a larger sample. The length of the postretention period was approximately 3 years in this study. This is not enough time to see all posttreatment changes. For example, Arnold2