Interarch tooth size relationships of 3 populations: “Does Bolton’s analysis apply?”

doi:10.1016/S0889-5406(00)70228-9

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 117, Issue 2, February 2000, Pages 169-174

https://doi.org/10.1016/S0889-5406(00)70228-9 Get rights and content

Abstract

This study evaluates whether Bolton’s interarch ratios extend across populations and genders. The data were derived from systematically collected preorthodontic casts of 180 patients, including 30 males and 30 females from each of 3 populations (black, Hispanic, and white). Forty-eight mesiodistal contact points were digitized on each model, and the lengths of the anterior, posterior, and overall arch segments were calculated. The results showed significant (P < .05) ethnic group differences in all 6 arch segment lengths and in all 3 interarch ratios. Whites displayed the lowest overall ratio (92.3%), followed by Hispanics (93.1%), and blacks (93.4%). The group differences were due primarily to the relationships between the posterior segments. The arch segments of males were significantly larger than females; the overall and posterior ratios were also significantly larger in males than in females. Multiple regression analyses showed that individual differences in the overall ratio were most closely associated with the size of the lower second premolar, followed by the upper lateral incisors, upper second premolars, and the lower central incisors. In combination, these 4 teeth explained approximately 50% of the variation in the overall ratio between subjects. We conclude that interarch tooth size relationships are population and gender specific. Bolton ratios apply to white females only; the ratios should not be indiscriminately applied to white males, blacks, or Hispanics. (Am J Orthod Dentofacial Orthop 2000;117:169-74)

Section snippets

MATERIAL AND METHODS

Preorthodontic records were systematically collected from consecutive cases treated between 1988 and 1997. The final sample included 180 persons, with 30 males and 30 females from each of 3 populations (black, Hispanic, and white). Subjects ranged between 12 and 38 years of age. To minimize error variance, the following selection criteria were used:

1.
A fully erupted permanent dentition from first molar to first molar
2.
Ethnicity verified by photographs and patient histories
3.
Good quality study models

RESULTS

Tables I and II show consistent population (P < .001) and gender (P < .019) differences in the lengths of all 3 arch segments (overall, anterior, posterior ) for both the maxilla and mandible.

. Population differences (mm) in overall, anterior, and posterior segment lengths

Segment	F-ratio	Significance	Populations
Segment	F-ratio	Significance	White	Black	Hispanic
Maxilla
Overall	13.51	<0.001	94.4	98.4	98.0
Anterior	7.14	0.001	46.7	48.4	48.3
Posterior	16.63	<0.001	47.7	50.0	49.6
Mandible
Overall	22.67	<0.001	87.2	92.0	91.1
Anterior	10.65	<0.001	37.2	38.4	38.9

DISCUSSION

The 3 populations exhibited significantly different relationships between the lower and upper teeth. Whites showed the smallest overall ratio, followed by Hispanics and blacks. The differences between blacks and whites were highly significant and indicate that relative to the maxillary teeth, the mandibular teeth of whites were smaller than the mandibular teeth of blacks. The difference between whites and blacks closely approximated the difference reported by Lavelle.²⁰ Lavelle also showed that

CONCLUSIONS

Mesiodistal and labial-lingual tooth dimensions, as well as overbite must all be considered for a complete assessment of interarch occlusal relationships. With respect to mesiodistal dimensions, 4 general conclusions can be drawn.

1.
Significant differences in the overall, anterior, and posterior interach ratios between whites, blacks, and Hispanics suggest that population specific standards are necessary for clinical assessments.
2.
Significant gender differences were shown for both the overall and

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The Saudi Digital Library, PubMed, Web of Science, Cochrane Library, Scopus, and Embase were searched systematically to acquire articles which reported OI and AI for Saudi patients; inclusion and exclusion criteria were applied. Data, including author’s name, publication year, city, measurement technique, number of subjects, type of occlusion, means, and standard deviations, were extracted and sorted. To assess the methodological quality of the included studies, The National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was utilized.
Of the 1473 articles, eight met the inclusion criteria and were included in the meta-analysis. Values for normal occlusion and Bolton’s values were not significantly different. All malocclusion classes showed significant differences in the overall OI and AI values compared with Bolton’s original values and values for normal occlusion, but they did not differ from each other. Gender showed an effect only on the OI ratio for Class III malocclusion.
Bolton’s original values can be used in Saudi patients only with normal occlusion. For cases with any Angle’s malocclusion, we recommend using an AI value of 79.08 (±3.4) for both genders. Classes I and II, regardless of gender, have the same OI value of 92.51 (±2.82). For Class III, values of 91.97 (±2.4) for females and 93.13 (±2.6) for males can be used.
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The anterior and overall Bolton ratios and their application in orthodontics are widely known. However, little has been reported about the posterior Bolton ratio, how it is affected by the extraction of posterior teeth, and its application in orthodontic treatment planning. This study aimed to investigate how extracting maxillary first and mandibular second premolars affects the posterior Bolton ratio.
The sample included 55 patients with Class I occlusion within 1 standard deviation of ideal anterior and overall Bolton ratios. The digitized models were subjected to virtual extraction of maxillary first premolars and mandibular second premolars and setup of posterior teeth in ideal occlusion. If space closure compromised occlusion, the teeth were moved to achieve ideal cusp-fossa or cusp-marginal ridge occlusion. The ideal setups were measured for residual interproximal spacing. Statistical analysis used R statistical software (version 2018; R Core Team, Vienna, Austria).
The ideal nonextraction posterior Bolton ratio was determined from the sample to be 105.77 ± 1.99%. The ideal expected posterior Bolton ratio for maxillary first and mandibular second premolar extraction patients was 106.52 ± 2.52%. This significantly differed from the expected posterior Bolton ratio for the 4 first premolar extractions. Patients finished with an average of 1.28 mm net residual spacing between mandibular first premolars and first molars; 38.2% of patients finished with at least 1.5 mm of residual space, and 9.1% of patients finished with at least 2 mm of residual space.
A patient with ideal anterior, posterior, and overall Bolton ratios treated with maxillary first and mandibular second premolar extractions to ideal occlusion will likely finish with some spacing in the mandibular dentition.
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This retrospective investigation aimed to compare Bolton's ratios among different malocclusion groups of Egyptian adolescent orthodontic patients with original Bolton's standards.
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The anterior mean ratio for the total sample were higher (79.4 ± 4.7) and overall mean ratio was lower (90.1 ± 5) than Bolton's standards. The differences between the obtained and standard values were statistically significant (P < 0.001). However, there were no significant differences in either anterior ratio (P = 0.637) or overall ratio (P = 295) regarding gender. Class I cases showed the highest mean anterior ratio of 80 ± 5.7 whereas class II and class III cases had the lowest ratio of 78.5 ± 4.6 and 78.7 ± 3.5, respectively. Concerning overall ratio, class III subjects had the highest ratio of 91.8 ± 2.6 with no substantial distinction from class II cases (90.2 ± 4.7) but was significantly different from class I cases that demonstrated the lowest ratio (89.7 ± 5, P = 0.020). High percentages of patients displayed clinically significant tooth size discrepancies (TSD), exceeding either above or below 2SD of Bolton's values, which were more marked in the anterior ratio. These were 25.2% and 7.4% for anterior ratio and 3.4% and 15.4% for overall ratio.
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Citation Excerpt :
Regarding crown width, this too tended to be greater in Italians than Mozambicans, albeit with statistical differences being detectable for the maxillary central incisors, canines and second molars, and only the second molars in the mandibular arch. The trend found is quite different than that reported by other authors.27-31 However, these differences could be due to the method of measurements (digital rather than analogical measurements) and to previous pooling of the entire data.
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Linear measurements and coordinates of each curve representing the clinical crown height and width of each tooth were acquired from digital models of each subject categorized to 1 of 2 groups: Italian (18 males, 22 females; mean age, 29.6 ± 5.7 years) or Mozambican (14 males, 15 females; mean age, 23.4 ± 5.9 years). All subjects had normal dentition and no previous orthodontic treatment, fillings, or prostheses. Method error and systematic error were calculated according to the Dahlberg formula (S² = ∑ d²/2n) and dependent Student t test (P <0.05), respectively. Tooth symmetry was investigated through a paired-samples t test (P <0.05) and sex difference via an independent-samples t test (P <0.05). After neither asymmetry nor sexual dimorphism was found, all data were pooled, inverting the signs of the X coordinates and then mirroring data. Subsequently, a 2-samples t test (P <0.05) and a multivariate cluster analysis were performed on the mirrored data to compare the 2 groups and to identify any within-group diversity for number of clusters for each tooth. Means of all linear measurements and coordinates (crown height and width) calculated for each cluster were reported and compared using a standard 2-samples t test (P <0.05).
Two clusters were identified for the maxillary second premolars and molars in Italian subjects, whereas in the Mozambican subjects, there were 2 clusters for the maxillary first premolars and lateral incisors and 3 clusters for the maxillary canines and central incisors. The mandibular arch was remarkably homogeneous, with only 1 cluster per tooth in each group. In the mandibular arch, statistical differences were recorded between ethnic groups in crown height at the central incisors and second molars and in crown width in the sector from the second premolar to the second molar.
There were considerable differences both between and within racial groups in crown height, crown width, and numbers of clusters, which should be taken into account during bonding. Although single-bracket placement guides specific for ethnicity may be feasible for the mandibular arch, the significant diversity in number of clusters in the maxillary arch indicates that more accurate bracket placement guides that take into account such heterogeneity are required.
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Interarch tooth size relationships of 3 populations: “Does Bolton’s analysis apply?”☆,☆☆

Abstract

Section snippets

MATERIAL AND METHODS

RESULTS

DISCUSSION

CONCLUSIONS

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Am J Orthod

Am J Orthod

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Am J Orthod Dentofacial Orthop

Dental Clinics of North America

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Am J Orthod Dentofacial Orthop

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Am J Orthod

Am J Orthod

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The philosophy of the tooth positioning appliance

Am J Orthod