Correlation between maxillary and mandibular base lengths and dental

crowding in Class II malocclusions in patients visiting tertiary care hospital

INTRODUCTION:

The term malocclusion was first described by Edward Hartley Angle in 1899. Malocclusion is

described as teeth that were rotated or irregularly aligned 1. Dental crowding is defined as a

discrepancy between size of tooth and size of arch resulting in teeth malposition and or rotation 2.

Crowding is one of the most primary reasons people seek orthodontic treatment 3. Myriad

of factors, particularly dental arch length and width, mesio-distal dimension of tooth, and dental

proportions, have been investigated and found to be associated to anterior dental crowding,

however, it is still a subject of discussion 4. It can be mild, moderate, or severe determined by the

size of the patient's jaw and the number of teeth involved 2, 5.

The relationship between dental crowding and size of tooth has previously been investigated,

although the results have been inconclusive 6. It is hypothesized that tooth size does not represent

the only factor in determining the origin of dental crowding 7. Lower anterior crowding is

directly related with the eruption of lower third molars 8. Crowding is typically associated with

dental arch widths, arch length, mesio-distal tooth dimensions and dental proportions 9. If

dental crowding is mostly caused by the first two issues and is mild to moderate in severity,

interproximal stripping and/or arch extension are more acceptable treatment options. However,

when dental crowding is moderate to severe and is caused by tooth size and transverse arch

dimension, it is highly likely that the underlying issue is inadequate apical base lengths 9.

Therefore, extractions would likely be the best therapeutic option in these instances.

A study conducted by RR Singh et al in 2019 with total 152 number of patients identified a

subjects with complete class II malocclusion and moderate to severe mandibular crowding have

significantly smaller base lengths as compared to the subjects with same malocclusion with
slight crowding or spacing 10. A weak to moderate inverse correlation was found between the

amount of dental crowding and maxillary and mandibular base lengths. An inverse correlation of

-0.377 was observed between mandibular crowding and maxillary base length (Co-Pt A), and -

0.247 between mandibular crowding and mandibular base length (Co-Gn). Strong positive

correlations of 0.570 and 0.608 were found between maxillary and mandibular crowding and

between maxillary and mandibular base lengths respectively 10.

In another study conducted by Waim Ijaz in 2015 with total number of 124 consecutive patients

(ages 14-25), showed patients with class II malocclusion had significantly smaller mandibular

base length correlation between mandibular dental crowding and mandibular base length (for

males, r = 0.148 and for females r = 0.199). these values shows a weak correlation between

mandibular base length and dental crowding11.

Only a limited number of studies have investigated the relationship between maxillary and

mandibular base lengths and dental crowding in patients of Class II malocclusions. Therefore,

the aim of this study is to evaluate the relationship of maxillary and mandibular base lengths to

the severity of dental crowding in patients with complete Class II malocclusion.

Objective:

 To determine the correlation between maxillary and mandibular base lengths and dental

crowding in patients with complete Class II malocclusion.

Operational Definitions:

Dental Crowding: Dental crowding is characterized by a discrepancy between tooth size and

jaw size that leads to a misalignment of the tooth row. It can result from excessively large teeth,

small jaws, or a combination of both. The severity of dental crowding is typically measured in

millimeters (mm) by subtracting the sum of the total tooth widths for each jaw from the
perimeter of the respective jaw bone arch. The difference in mm determines the degree of

severity of dental crowding. Mild crowding <3mm and moderate to severe crowding ≥3mm.

Open bite: In open bite, there is no vertical overlap between upper and lower incisors. It is

measured from upper incisal edge to lower incisal edge in mm. 0-2 mm overlap considered as

ideal. Less than 0 overlap considered as open bite.

Cross bite: A cross bite is a type of malocclusion, or a misalignment of teeth, where upper teeth

fit inside of lower teeth. This misalignment can affect a single tooth or groups of teeth, involving

the front teeth, back teeth, or both: Posterior cross bite: If the back teeth are affected, upper teeth

sit inside of bottom teeth.

Maxillary base length: It is a linear measurement which is measured from cephalometric

landmark Condylion (Co) to point A.

Mandibular base length: It is a linear measurement on cephalometric landmark between

Condylion(Co) to Gnathion(Gn).

MATERIALS AND METHOD:

Study Design: Cross sectional study

Study Setting: Department of Orthodontics, Nishtar Institute of Dentistry Multan.

Duration of Study: Six months after the approval of synopsis.

Sample Size: The sample size is calculated through online software

http://sample-size.net/correlation-sample-size/. A minimum of 126 participants will be required

in order to determine the correlation r = 0.247, with a power of 80%, using two sided

significance level of 0.05 10 .

Sampling Technique: Consecutive sampling technique.

Inclusion Criteria:
 1. Patients between the ages of 18-40 years.

2. Both male and female.

3. Presences of a complete (full cusp) Class II malocclusion (molar relationship) with no

open bite and cross bite

4. Presence of all permanent teeth up to the first molars.

Exclusion Criteria:

1. Dental and craniofacial abnormalities

2. Previous orthodontic treatment.

DATA COLLECTION PROCEDURE:

Ethical approval for the study will be obtained from the ethics committee at Nishtar Institute of

Dentistry, Multan, Pakistan. A written informed consent form will be obtained from all the study

participants. 126 patients who satisfy the inclusion criteria will be selected. The pre-treatment

dental casts and lateral cephalograms will be measured. All lateral cephalograms will be obtained

using the same radiography device and traced by the single examiner. Tracing on acetate sheets

will be using a 0.35" pencil. The mesio-distal diameters of individual teeth will be measured by

using a Vernier caliper. Crowding and maxillary & mandibular base lengths will be measured as

per operational definition. All the data will be noted on proforma (attached).

DATA ANALYSIS: The statistical data analysis will performed by using SPSS version 25.

Quantitative variable i.e. age, base lengths and crowding will be presented as mean and standard

deviation. Qualitative variables, gender and residential will be presented as frequency and

percentage. Correlation between the maxillary and mandibular base lengths and dental crowding

will be determined through the Pearson correlation (r). Data will be stratified on age, gender,
residential area to determine the effect on correlation between arch perimeter and base lengths

using Pearson coefficient. The p ≤0.05 will be set a significance level.

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 Performa

Relationship between maxillary and mandibular base lengths in Class II

malocclusions in patients visiting tertiary care hospital

Reg #: __________________________________________________________

Name: __________________________________________________________

Age: ______ years

Gender: Male/ Female

Residence: Rural / Urban

Cephalometrics parameters (mm):

Maxillary base length (Co-A): _______mm

Mandibular base length (Co-Gn): ______mm

Dental crowding on cast in mm:

In maxilla:

Crowding <3mm Crowding ≥3mm

In mandible:

Crowding <3mm Crowding ≥3mm