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Print version ISSN 1678-7757
J. Appl. Oral Sci. vol.19 no.2 Bauru Mar./Apr. 2011
Fabiane LoulyI; Paulo Roberto Aranha NouerII; Guilherme JansonIII; Arnaldo PinzanIV
IDDS, MSc, Graduate student, Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
IIDDS, MSc, PhD, Professor. Private practice, São Paulo, SP, Brazil
IIIDDS, MSc, PhD, M.R.C.D.C. (Member of the Royal College of Dentists of Canada), Professor and Head, Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
IVDDS, MSc, PhD, Associate Professor, Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
OBJECTIVE: This study evaluated dental arch dimensional changes of Brazilian children.
MATERIAL AND METHODS: Dental casts were taken from 66 children (29 males; 37 females) with normal occlusion selected among 1,687 students from public and private schools aged 9, 10, 11 and 12 years, according to the following criteria: Class I canine and molar relationships; well-aligned upper and lower dental arches; mixed dentition; good facial symmetry; no previous orthodontic treatment. Dental arch dimensions were taken by one examiner using the Korkhaus' compass and a digital pachymeter. ANOVA test was applied to compare the arch dimensions at the different ages and the t-test was used to compare the arch dimensions of male and female subjects. Arch forms were compared by means of chi-square tests.
RESULTS: Only the maxillary anterior segment length showed a statistically signifcant increase from 10 to 12 years of age. Males had a signifcantly larger maxillary depth than females at the age range evaluated. The predominant dental arch form found was elliptical.
CONCLUSIONS: In the studied age range, anterior maxillary length increased from 10 to 12 years of age, males had larger maxillary depth than females and the predominant arch form was elliptical.
Key words: Dental arch. Growth. Mixed dentition.
The width, length and depth of dental arches have had considerable implications in orthodontic diagnosis and treatment planning in a modern dentistry based on prevention and early diagnosis of oral disease7.
These dental arch dimensions systematically change during the period of intensive growth and development, but lessen at adulthood7. Because of this, many studies have investigated arch dimensional changes in various stages of growth and development, such as arch width and arch dimensions2,3,7,17,18,23.
During the mixed dentition, the changes that occur in the dental arches are consequences of tooth movement and growth of supporting bone, besides modest genetic component8. These naturally occurring changes, which happen in untreated individuals, have been used for many times, as comparative “gold standards", which have been employed to assist the diagnosis and orthodontic planning7.
It has been reported that growth and development period have been infuenced by environmental factors, nutrition, and ethnic variations; systemic, health, and individual variations could also occur3. Therefore, a standard measurement defnition for dental arches has become more diffcult in a great mixed population and these differences could affect clinical treatment.
Not only it is obvious that the clinician treats the individual and not a segment of population, but it is also true that people from different ethnic groups present different modal conditions. The clinician should anticipate the differences in size and form rather than treating all cases with a single ideal.
A number of researches have attempted to identify dental arch characteristics, which have been unique to a certain ethnic group. Nojima, et al.20 (2001) compared Caucasian and Japanese mandibular clinical arch forms. Defraia, et al.11(2006) studied dental arch dimensions in the mixed dentition of Italian children. Lindsten, et al.16 (2002) evaluated transverse dental arch dimension and dental arch depth dimensions in mixed dentition of Norwegian children. Yuen, et al.30 (1988) performed a mixed dentition analysis for Hong Kong Chinese children. Burris and Harris6 (2001) evaluated the maxillary arch size and shape in American Black and White children.
The Brazilian population, which has a great ethnic diversity, can present different characteristics from those observed in the studies carried out in samples of Caucasian countries, Eastern countries or other countries. Based on the hypothesis that these dental occlusion maturation characteristics could have been infuenced by this ethnic diversity pattern and that occlusal changes could have occurred even in patients with normal occlusion, the aim of this study was to evaluate the changes that could occur in dental arches, in the mixed dentition of Brazilian children.
MATERIAL AND METHODS
Dental casts were taken from 66 children (29 males; 37 females) with normal occlusion that were selected among 1,687 students from public and private Brazilian schools aged 9, 10, 11 and 12 years, who met the following criteria: Class I canine and molar relationships; well-aligned upper and lower dental arches; mixed dentition; good facial symmetry clinically determined; no signifcant medical history; no history of trauma and no previous orthodontic or prosthodontic treatment.
Dental arch dimensions of width, length and depth were taken by one examiner using the Korkhaus' compass and a digital pachymeter.
To examine the total length of dental arch, the perpendicular distance from the line which connects the central incisors and the raphe point up to the line of depth of the frst molar was used. The length of the anterior segment of the arch was evaluated through the perpendicular distance from the line which connects the central incisors up to the canine's distal line. Length of the posterior segment of the arch was observed by the difference between the total length and the anterior segment length of the arch (Figure 1).
The intercanine width was observed by the distance between the cusp tips of the right and left canines. Inter-frst-premolar width was given by the distance between the central sulcus of the right and left frst premolars or primary second molar. Interfrst-molar width was evaluated by the distance between the central sulcus of the right and left frst molars. Inter-second-molar width was observed by the distance between the central sulcus of the right and left second molars (Figure 1).
Maxillary depth (Figure 2) was measured from a line which connects the occlusal plane up to the greatest palatal depth. The form of the dental arch was defned based on cusp tips and incisor edges and then classifed as: ellipse9, parabola13, segments of circles joined to straight lines, or modifed spheres5,26.
Some maxillary and mandibular second molar widths were not measured because these teeth were not present yet.
Every 66 dental casts were measured again after 10 days from the frst measurement, by the same examiner. The casual error was calculated according to Dahlberg's formula (S2=Σd2/2n), where S2was the error variance and d was the difference between the two determinations of the same variable10. Kappa test was used to evaluate the systematic error of the dental arch form. Intraexaminer agreement was tested with intraclass coeffcients generated by Kappa statistics15.
The intergroup comparisons of the ages were performed with one-way ANOVA, followed by Tukey's test as a second step. T-tests were applied for comparison between males and females. The form of the arch was evaluated with chi-square test. Results were considered statistically signifcant at P<.05.
Casual errors varied from 0.0 for the anterior mandibular segment length to 0.076 mm for the posterior maxillary segment length. The systematic error of dental arch form, according to Kappa statistical coeffcients, showed a moderate level of intraexaminer agreement.
Descriptive statistics (mean, standard deviation) are shown in Table 1. The total length and all maxillary measurements increased, but did not obtain statistical signifcance. The maxillary anterior segment length was signifcantly larger at 12 as compared to 10 years of age (Table 1).
Mandibular measurements had small changes and no statistically differences were found.
Descriptive statistics and comparisons of the males and females in each age-group (according to independent samples t-test P<0.05) were described in Table 2. Males showed a signifcantly larger maxillary depth than females to 10 years of age (Table 2). The ellipse form9 was the most frequent dental arch form found in the sample studied (Table 3).
In this study, when comparing children ages, only the maxillary anterior segment length showed statistically signifcant differences and the 12-year old children exhibited a maxillary anterior segment length greater than 10-year old children (Table 1). Signifcant changes occurred in the dental arches during the early mixed development period. Eruption of the permanent incisors resulted in an increase of the anterior segment, especially in the maxilla, and with eruption of the permanent canines, a further minor increase occurred27.
It was found an insignificant increase in maxillary arch total length, from 9 to 12 years. A little decrease in mandibular arch total length was also found and this arch length seemed to remain constant after 12 years. These results are similar to those of a longitudinal study of dental arches in a Turkish population, where the maxillary arch length increased until 13 years and showed a little decrease starting from 9 years1.
Arch length decreased between the ages of 9 and 14 years due to changes in the dentition and it remained constant after the age of 142,18. The main causes of these length changes have been the closure of posterior interproximal spaces by the replacement of the primary dentition with the permanent dentition, and the interproximal contacts made by the permanent teeth2,18.
There was an insignifcant decrease in maxillary and mandibular posterior segment length. This decrease should be related to the mesial shifting of the frst molars due to leeway space closure27. This is in agreement with the dental arches measurements found on a Turkish population1. Lundstrom17 (1969) evaluated age-related changes in dental arches, and followed 41 pairs of twins, males and females, from an initial age of 9 to 19 years and found decreases in maxillary and mandibular length.
Our study found a mandibular decrease and a maxillary increase in intercanine widths. This was similar to the Iowa growth study and the untreated UMGS (University of Michigan Growth Series) study sample19. This trend was observed for the mandibular and maxillary results, but these variations were not statistically signifcant.
Intercanine widths were studied by Barrow and White2 (1952), Moorrees18 (1959), and Sillman23(1964) who observed a rapid increase between the ages of 6 and 9, which have been associated to the eruption of the permanent canines and incisors. According to Moorrees18 (1959) a decrease have occurred between the ages of 10 and 12, with no change after that. However, other authors suggested that intercanine width have continued to decrease after age 122,18,23.
In a longitudinal study performed by Knott14(1972) there has been an average change in the intercanine width during the transition from primary to the permanent dentition, however, with high individual variations. Sinclair and Little24 (1983) found a decrease in mandibular intercanine width between the mixed and early permanent dentitions. In our study, there was a non-signifcant slight increase for the maxillary intercanine width and a decrease for the mandibular intercanine width. These differences could be related to genetic or ethnic variations.
The variation of the premolar width was greater for the mandibular arch, but it was not statistically signifcant. The fndings of this study, as well as, those of Bishara, et al.3 (1997) and the Michigan Growth Study19 (1976) indicated that most arch widths dimensions have been established in the mixed dentition. The results of the Michigan Growth Study19 (1976) showed that the premolar width have increased in both jaws, which have been greater in the maxillary than in the mandibular dental arch. In our study, although without statistically signifcant difference, maxillary and mandibular first and second intermolar widths increased, confrming that the studied period of time represented when most of the transverse growth of the molar region have occurred1.
In a study conducted in the United Kingdom, decreases have been found in intermolar widths between the ages of 11 and 1429. Lindstron16 (2002) found minimal increases in permanent intermolar width between ages of 9 and 19. Moorrees18(1959) found that the mandibular intermolar width increased between the ages of 9 and 14 and remained constant after the age of 14. Our results are consistent with these increases during the studied period of time. Odajima21 (1990) performed a longitudinal study on growth and development of dental arches of primary, mixed and permanent dentitions and found a gradually increase for the width at the region of the permanent maxillary and mandibular frst molars, which have reached a stable condition at about 12 years of age.
Cassidy, et al.8 (1998), Staley, et al.25 (1985), Raberin, et al.22 (1993), studying the widths of dental arches, found several maxillary or mandibular widths larger in male than in female subjects. However, in the present investigation, just one variable (maxillary depth) showed a statistically significant sexual dimorphism to 10 years of age (Table 2). From the studies of dentofacial development, it is known that sagittal growth of the nasomaxillary complex is the result of anterior displacement of the maxilla due to bone deposition at the tuberosity and adjacent structures, thus creating space for eruption of the posterior teeth. Vertical growth is the combined result of a sutural lowering of the maxilla as a whole and remodeling at the bone surfaces4. This lowering creates space for the nasal cavity, which continues to be lowered due to resorption nasally with simultaneous deposition of bone orally on the palate. Vertical growth is hence a result of two separate processes: drift resulted of remodeling growth, and displacement of the maxilla as a whole, a procedure that occurs without any kind of rotation28. With premolars and molars in occlusion, there should not be any further increase of the alveolar process and hence no further increase of palatal height27. The continuous increase of palatal height observed in the present study seems to be an effect of a slow continuous eruption of the teeth. Even if the mechanisms of tooth eruption have still not been fully elucidated, the slow continuous increase of this distance seems to indicate an important role in the eruption mechanisms27.
The findings of a large variation indicate that the dental arch form has no single and universal form12. These observations are strengthened by different facial patterns and stratifed ethnic groups in this investigation. Raberin, et al.22 (1993) studied mandibular arch form in subjects with normal occlusion, and concluded that at least fve different forms are among the most frequently seen. In the light of the large individual variation in arch form in the present sample, the dental arch form predominantly found was the elliptical9 (86.4%) (Table 3).
In conclusion, in the studied age range, anterior maxillary length increased from 10 to 12 years of age, males had larger maxillary depth than females and the predominant arch form was elliptical.
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Dra. Fabiane Louly
Faculdade de Odontologia de Bauru - USP - Departamento de Odontopediatria, Ortodontia e Saúde Coletiva - Disciplina de Ortodontia
Alameda Octávio Pinheiro Brisolla, 9-75
Bauru, SP - Brazil - 17012-901
Received: June 26, 2009
Modifcation: March 16, 2010
Accepted: May 25, 2010