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Mixed Dentition Analysis: Applicability of Three Non-Radiographic

Methods for Patiala Population
Savita Garg1, Anuradha Pathak2, Surinder Kaur3

of Moyers, Bachmann and Trankmann et al mixed dentition

ABSTRACT analysis methods for Patiala population.
Introduction: The present study was undertaken to evaluate MATERIAL AND METHODS
the accuracy of methods proposed by Moyers, Bachmann and
Trankmann et al to forecast the mesiodistal dimensions of A total of 50 children (27 boys and 23 girls) in the age group
permanent canine and premolars in Patiala population. of 11-14 years of Patiala City population were taken for the
Material and Methods: Mesiodistal dimensions of teeth were present study.
measured from study models representing 27 male and 23 The following selection criteria were used:-
female subjects (aged 11–14 years) of North Indian descent. • All the subjects had permanent dentition.
The mesiodistal dimensions of the teeth were measured • No active caries or restorations were present.
using a digital caliper (providing measurements to 0.01 mm • No obvious anomalies regarding number, form, size or
accuracy). The measurements of canine and premolars were
structure of the teeth were there.
summed up and compared with those derived from Moyers
• The mesiodistal and buccolingual surfaces of the crowns
probability tables (75th percentile), and Bachmann and
Trankmann et al equations. of all permanent teeth were intact.
Results: All the three methods exhibited overestimation of • Relatively well aligned arches which enabled the
actual sum of permanent canine and premolars in both the measurement of mesiodistal widths.
arches and genders in this population. These values were • The subjects had no history of previous orthodontic
found to be statistically significant. treatment.
Conclusion: All the methods evaluated in the study Informed consent was taken from all the study subjects.
overestimated the mesiodistal widths of permanent canine and Impressions for all the subjects were made in alginate
premolars in North Indian population. However, Moyers at impression material and were poured using dental stone,
75th percentile gave relatively closer estimate as compared to without delay to prevent dimensional changes. The
Bachmann and Trankmann et al equations for both arches in
measurements of teeth on dental casts were done using
males as well as females.
a calibrated digital caliper with an accuracy of 0.01 mm.
Keywords: Bachmann Analysis, Mixed Dentition, Moyers The mesiodistal dimensions of permanent canines and
Analysis, Trankmann et al Equation. premolars of both the jaws were measured and recorded. All
measurements were carried out twice and the mean of the
two values was used.
The methods which were compared are:
INTRODUCTION
Moyer's method (1988):
The period of mixed dentition is a critical period for the
According to Moyers' method the sum of the mesiodistal
prevention or interception of any developing malocclusion.
widths of the permanent mandibular incisors is calculated
Early diagnosis and successful treatment of dento-alveolar
to predict the sum of mesiodistal dimensions of mandibular
discrepancies can help in achieving the goal of occlusal
and maxillary permanent canines and premolars at various
harmony, function and dento-facial aesthetics. The method
probability levels (5% to 95%). Hence, the mesiodistal
of mixed dentition analysis is a diagnostic tool that allows to
dimensions of the mandibular permanent central and lateral
quantify crowding and to predict dentoalveolar discrepancy
incisors were measured from the dental casts and recorded.
by identifying the available and necessary space for teeth
The sum of mesiodistal dimensions of all the four mandibular
not yet erupted. Several methods have been developed
incisors was calculated and this value was used to predict
for estimating the mesiodistal widths of unerupted teeth.
The development of these methods was based on the data
derived from the population of various descents. Therefore, Post Graduate Student, 2Professor and Head, 3Demonstrator,
1

the accuracy of these prediction methods may be in question Department of Pedodontics and Preventive Dentistry, Government
when applied to other population groups because it has Dental College and Hospital, Patiala, Punjab, India
been well established in the literature that tooth sizes vary
considerably between the racial groups. Hence, this study Corresponding author: Dr. Savita Garg, #217, Maharaja Yadvindra
Enclave, Nabha Road, Patiala, Punjab, India. Pin-147001
was an attempt to compare three different types of mixed
dentition analysis methods (Moyers, Bachmann and How to cite this article: Savita Garg, Anuradha Pathak, Surinder
Trankmann) and to determine the most applicable method Kaur. Mixed dentition analysis: applicability of three non-
for boys and girls of Patiala population.1-3 radiographic methods for patiala population. International Journal
The aim of the present study was to evaluate the applicability of Contemporary Medical Research 2017;4(9):2016-2019.

2016
International Journal of Contemporary Medical Research
Volume 4 | Issue 9 | September 2017 | ICV: 77.83 | ISSN (Online): 2393-915X; (Print): 2454-7379
Garg, et al. Mixed Dentition Analysis

the width of permanent canines and premolars of both jaws of maxillary and mandibular incisors, canines, premolars
according to Moyer’s probability charts at 75th percentile and first molars were subjected to statistical analysis, and
levels. The predicted values of permanent canines and the mean values and standard deviation were derived for
premolars of both the jaws were compared with the actual males and females separately. Paired t test was used for the
values recorded. comparison.
Bachmann's method (1986) RESULTS
Mesiodistal dimensions of upper permanent left lateral
No significant differences were present between teeth in left
incisor, upper permanent left first molar and lower permanent
and right sides, where P value > 0.05 showing no statistically
left lateral incisor of each patient were measured from the
significant difference in size of teeth of both the sides.
dental cast and recorded. According to Bachmann’s method,
mesiodistal of unerupted permanent canines and premolars Sex comparisons of mesiodistal tooth widths: The
were calculated with following regression equations: dimensions of both maxillary and mandibular canine and
Maxilla = 0.81× (22) +0.54× (26) +0.56× (32) +6.98 premolars were greater in males than in females and the
Mandible = 0.71× (22) +0.39× (26) +0.86× (32) +6.96 difference was significant statistically (p < 0.005). (Table 1)
where 22 represents mesiodistal dimension of upper left Comparisons of predicted and actual tooth size:
lateral incisor, 26 represents mesiodistal dimension of upper Measurements on the left side of the dentition were
left first permanent molar and 32 represents mesiodistal considered. The two‑tailed t test was employed to compare
dimension of lower left lateral incisor of each patient. The the differences between the actual and predicted mesiodistal
calculated values of permanent canines and premolars of dimensions of the sum of unerupted permanent canines,
both the jaws were compared with the actual values measured first and second premolars. All the three methods; Moyers,
from the dental casts of each patient. Bachmann’s and Trankmann et al exhibited overestimation
Trankmann et al. (1990) method: when the predicted values were compared with actual sum of
Trankmann gave following equations to predict the width of permanent canine and premolars in males as well as females.
unerupted permanent canines and premolars. The difference was highly significant (p < 0.01). (Tables 2-4)
Boys:
DISCUSSION
Maxilla = 0.93X + 5.50,
Mandible = 0.94X + 5.06 The present study was an attempt to establish the validity of
Girls: Moyers prediction tables, Bachmann and Trankmann et al
Maxilla = 0.99X + 4.47, equations for mixed dentition analysis in a sample of Patiala
Mandible = 0.96X + 4.43 population. This cross-sectional study was undertaken on a
where X represents sum of mesiodistal dimension of lateral random sample of school children, 11-14 years of age, living
incisor and mesiodistal dimension of first permanent molar in Patiala City.
of respective quadrant of each patient. Hence, mesiodistal In this study, there were no statistically significant differences
dimensions of lateral incisors and first permanent molars between the left and right sides. These findings indicate that
were measured from the dental casts and according to either the right or the left side measurements could be used
above regression equations mesiodistal widths of permanent to represent the mesiodistal tooth widths for this sample.
canines and premolars of both the jaws were calculated and Therefore, the values of the left sides of each jaw were used
compared with actual values. in the statistical analyses. The results of unpaired t tests
showed that there were statistically significant differences
STATISTICAL ANALYSIS in the tooth widths between the male and female subjects.
Descriptive statistical analysis of the measured teeth The mean mesiodistal tooth widths of male subjects were
dimensions and comparison of actual teeth sizes between generally larger than those of females in both mandibular
right and left sides was done. The mesiodistal dimensions and maxillary dental arches (p < 0.05). Thus, data analysis

Males Females t value significance

Mean (mm) SD Mean (mm) SD
Mandibular C 7.62 0.44 7.08 0.42 4.41 <0.001*
Mandibular PM1 7.05 0.46 6.64 0.40 3.33 <0.005**
Mandibular PM2 6.99 0.36 6.58 0.44 3.62 <0.001*
Mandibular M1 10.97 0.43 10.53 0.36 3.88 <0.001*
Maxillary C 7.94 0.38 7.56 0.41 3.40 <0.005**
Maxillary PM1 7.34 0.42 6.88 0.38 3.15 <0.005**
Maxillary PM2 6.98 0.38 6.15 0.45 3.19 <0.005**
Maxillary M1 10.22 0.42 9.85 0.42 3.11 <0.005**
Sum of mandibular incisors 23.03 1.22 22.78 1.20 3.06 <0.005**
*Highly significant, ** Very Significant, C – Canine, PM1 – First Premolar, PM2 – Second Premolar, M1 – First permanent molar
Table-1: Mean mesiodistal widths of the mandibular and maxillary teeth in males and females

International Journal of Contemporary Medical Research 2017

ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 77.83 | Volume 4 | Issue 9 | September 2017
Garg, et al. Mixed Dentition Analysis

Prediction methods Predicted values of Actual Values of C+P- Difference predicted/ Significance (p value)
C+PM1+PM2 (in mm) M1+PM2 (in mm) actual (in mm)
Mandibular
Moyers 21.03 + 0.81 20.23+ 1.18 0.80 + 0.62 0.01
Bachmann 21.27 + 0.90 20.23 + 1.18 1.04 + 1.41 <0.001
Trankmann et al 21.11 + 0.66 20.23 + 1.18 0.88 + 0.54 0.005
Maxillary
Moyers 21.58 + 0.36 20.94 + 1.24 0.68 + 0.91 <0.05
Bachmann 22.28 + 0.90 20.94 + 1.24 1.34 + 0.65 <0.001
Trankmann et al 21.98 + 0.67 20.94 + 1.24 1.04 + 0.94 <0.001
Table-2: Actual and predicted Sum of C+PM1+PM2 (mandibular and maxillary), mean differences, and standard deviations with all
the three methods in Females

Prediction methods Predicted values of Actual Values of C+P- Difference predicted/ Significance (p value)
C+PM1+PM2 (in mm) M1+PM2 (in mm) actual (in mm)
Mandibular
Moyers 21.66 + 0.54 21.12 + 1.15 0.54 + 0.49 0.031
Bachmann 21.84 + 0.54 21.12 + 1.15 0.72 + 0.50 0.004
Trankmann et al 22.16+ 0.70 21.12 + 1.15 1.04 + 0.59 0.001
Maxillary
Moyers 22.00 + 0.61 21.37 + 1.14 0.63 + 0.14 0.014
Bachmann 22.74 + 0.96 21.37 + 1.14 0.86 + 0.49 0.000
Trankmann et al 22.54 + 0.61 21.37 + 1.14 1.05+ 0.44 0.000
Table-3: Actual and predicted C+PM1+PM2 (mandibular and maxillary), mean differences, and standard deviations with all the three
methods in males.

Method Males Females

Maxillary arch Mandibular arch Maxillary arch Mandibular arch
Moyers 0.684 0.616 0.645 0.615
Bachmann 0.555 0.521 0.509 0.499
Trankmann et al 0.475 0.496 0.490 0.478
Table-4: Correlation coefficients for all the three methods in males and females

was performed separately for each gender. These results should be done for an accurate treatment plan. Thereafter,
agree with many studies that have also found the average many studies aiming to test and confirm the applicability
mesiodistal widths of individual teeth of permanent dentition and consistency of these methods in different populations
in males to be larger than in females in many ethnic groups. have been performed. Ballard and Wylie (1947) developed
The results of this study show that all the three mixed a prediction method by correlating the sum of mesiodistal
dentition analyses overestimate the actual value of widths of four mandibular incisors with the combined widths
permanent teeth. However Moyers probability tables at 75th of mandibular canines and premolars on one side of the arch.
percentile gave relatively more appropriate estimate of width The correlation coefficient was found to be moderately
of unerupted canine and premolars as compared to Bachman positive(r = 0.64). Singh and Nanda (1972) discovered that
and Trankmann et al mixed dentition analyses for the upper the values for the Indian children were very different from
and lower arch in males as well as females. those of Caucasian children, from which they concluded that
Different racial and ethnic groups can have variations in the there were racial discrepancies in tooth size and therefore
tooth and facial characteristics. Most methods, used to predict data collected from one ethnic group were not transferrable
the widths of unerupted permanent teeth, were developed to other.7-10
based on the North American and European populations. This has been demonstrated in the present study by significant
The accuracy of these prediction methods when applied to amount of differences between the mean values of actual
population groups other than white subjects is, however,
mesiodistal widths of permanent canines and premolars
questionable because it has been well established in the
and those derived from Moyers, Bachmann and Trankmann
literature that tooth sizes vary considerably between different
et al prediction equations for children from northwestern
racial groups. Racial and gender specific mixed dentition
European ancestry.
space analyses require revision or validation once every
generation (approximately 30 years) because of changing Limitations of study: The sample size in the present study
trends in malocclusion and tooth size. The accurate width could have been larger. Using the larger sample a regression
of an unerupted tooth is important for correct diagnosis of a equation to predict the mesiodistal widths of permanent
case.3-6 Neither overestimation nor underestimation of width canine, first and second premolars can be arrived at.

2018
International Journal of Contemporary Medical Research
Volume 4 | Issue 9 | September 2017 | ICV: 77.83 | ISSN (Online): 2393-915X; (Print): 2454-7379
Garg, et al. Mixed Dentition Analysis

CONCLUSION
Source of Support: Nil; Conflict of Interest: None
Tooth widths exhibit statistically significant differences
Submitted: 10-09-2017; Accepted: 09-10-2017; Published: 21-10-2017
between male and female subjects, with male teeth generally
being larger. Thus, Patiala children should be divided
according to gender prior to a mixed dentition analysis.
The mixed dentition space analyses proposed by Moyers,
Bachmann and Trankmann et al show overestimation of
the mesiodistal widths of maxillary and mandibular canine
premolar segment in both males and females.
The Moyers mixed dentition analysis method at 75th
percentile gave relatively closer estimate for prediction of
mesiodistal dimensions of permanent canines and premolars
amongst the methods compared in Patiala population.
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International Journal of Contemporary Medical Research 2019

ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 77.83 | Volume 4 | Issue 9 | September 2017