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ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 1  |  Page : 52-57

Applicability of Moyers' and Tanaka–Johnston's mixed dentition analyses for predicting canine and premolar widths in south Indian population - A cross sectional study


Department of Pedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India

Date of Web Publication14-Jun-2017

Correspondence Address:
Rekhalakshmi Kamatham
Department of Pedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh 524003
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jofs.jofs_110_16

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  Abstract 


Aim: To test the applicability of Moyers’ and Tanaka–Johnston’s (TJ) mixed dentition analyses in predicting canines (C) and premolars (Ps) dimensions in South Indian population. Materials and Methods: A total of 100 boys and 101 girls in the age range of 11–15 years were recruited into the study. Maxillary and mandibular arch impressions were made and poured with dental stone. The maximum mesio-distal widths of mandibular central and lateral incisors, maxillary and mandibular C and Ps were measured. The predicted values of C and Ps obtained using Moyers’ and TJ methods were correlated and compared with the actual tooth sizes using Pearson correlation test and paired t test, respectively. Results: Moderate positive correlations were observed between the actual measurements and the predicted values obtained using both TJ and Moyers’ methods, irrespective of the gender. However, the validity, as tested using paired t test showed no applicability of TJ and Moyers’ (35 and 75%) methods. On the other hand, Moyers’ 50% was applicable for both the arches in boys and 65% for girls only in the maxillary arch. Conclusion: TJ and Moyers’ methods cannot be applied in the present population (Southeast India); hence, population adjusted regression equations have to be formulated.

Keywords: Mixed dentition analysis, Moyers’, Tanaka–Johnston


How to cite this article:
Kamatham R, Vanjari K, Nuvvula S. Applicability of Moyers' and Tanaka–Johnston's mixed dentition analyses for predicting canine and premolar widths in south Indian population - A cross sectional study. J Orofac Sci 2017;9:52-7

How to cite this URL:
Kamatham R, Vanjari K, Nuvvula S. Applicability of Moyers' and Tanaka–Johnston's mixed dentition analyses for predicting canine and premolar widths in south Indian population - A cross sectional study. J Orofac Sci [serial online] 2017 [cited 2020 May 27];9:52-7. Available from: http://www.jofs.in/text.asp?2017/9/1/52/207937




  Introduction Top


Early intervention of space discrepancies can prevent a potential dental irregularity from progressing into a more severe form, thus, preventing future malocclusions in children.[1] One of the pre-requisites for diagnosing these discrepancies is mixed dentition analysis (MDA), which ideally should possess the character to accurately predict the dimensions of the un-erupted permanent teeth.

Various methods have been developed for the prediction of the mesio-distal widths (MDWs) of the un-erupted canines (C) and premolars (Ps); which can be summarized into measurement of teeth on radiographs,[2] estimation based on the dimensions of erupted permanent teeth using prediction tables,[3],[4] and a combination of these.[5],[6] Radiographic methods are not commonly employed due to the demerits of exposure and image distortion. Among the non-radiographic methods, Moyers’ and Tanaka–Johnston’s (TJ) analyses are frequently used; the proposed advantages with these systems being simplicity, ease of calculation, possibility of using on both the dental arches as well as on both the genders with good accuracy.[3],[4] The estimation of C and Ps dimensions in these systems is based on the mandibular permanent incisors, because these are the first permanent teeth to erupt in mixed dentition with an additional advantage of less variability in shape and size, ease, and accuracy in measuring and also reported to have a high correlation with other groups of teeth.[7]

Although Moyers’ and TJ analyses are widely followed, these methods are based on data derived from a population of North European descent (Caucasians).[1],[2],[8],[9] Therefore, the accuracy of these prediction methods for populations of other ethnic origin is questionable. Moreover, the change in tooth dimensions owing to secular trends is well evident in literature.[10] These necessitate progressive modification of MDA for different populations, at least once in every generation. Considering the above facts, validation of these analyses has been tested worldwide in many countries[2],[8],[9],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22] including some parts of India.[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35] The present study was planned to determine the accuracy of Moyers’ and TJ methods of prediction in the hitherto unreported population of South Andhra Pradesh (Southeast India).


  Materials and Methods Top


Sample

Ethical approval for this study was provided by the institutional ethical committee, Narayana Dental College and Hospital, (R.C.No.NDC/FAC/2014-15/EC/2014) on 31-12-2014. Children attending the Department of Pedodontics and preventive dentistry and school dental health programs who fulfilled the following inclusion criteria were recruited into the study:
  1. Age range of 11–15 years (using gender stratified random sampling).
  2. Belonging to Nellore (Southeastern India) ancestry, at least from one previous generation.
  3. Presence of fully erupted permanent dentition (except third molars) with intact proximal surfaces, marginal ridges, incisal edges and contact points.
  4. Class I canine and molar relationship.
  5. Who gave their assent and whose parents gave written consent to participate.


Children with abnormalities in teeth number, shape, size or structure, apparent loss of tooth substance due to attrition, trauma, massive caries or artificial crowns on teeth, transverse discrepancies such as cross bite, history of orthodontic treatment, facial disharmony and/or congenital craniofacial anomalies were excluded.

Impressions of maxillary and mandibular arches were made with dentulous, perforated impression trays using irreversible hydrocolloid, and poured with hard dental stone immediately to avoid dimensional changes and vibrated manually. Each model pair was assigned an identification number to ensure examiner masking for gender.

The actual MDWs of mandibular central and lateral incisors, maxillary, and mandibular C and Ps were measured using electronic digital Vernier Caliper (aerospace 0150 mm with a resolution of 0.01 mm). The standard method of Moorrees and Reed,[7] which involves measuring the distance between anatomic contact points (from mesial to distal) at their greatest inter-proximal distance using sharp end calipers on the facial side was used. The C and Ps dimensions were predicted using TJ and Moyers’ methods. The actual and predicted MDWs of C and Ps were tabulated and analyzed statistically.

Sample size determination

On the basis of the data obtained from the pilot study (conducted on 15 children), taking alpha error as 0.05, power of 95% and considering 10% for errors, a total sample size of 150 was determined.

Intra and inter-examiner reliability

The intra-examiner calibration procedure consisted of measuring randomly selected 15 model pairs twice by one of the investigators with a time lapse of 1 week. The inter-examiner calibration was performed against another examiner, who also repeated the same procedure.

Statistical analysis

Statistical analysis was performed using the Statistical Package for the Social Sciences (version 17.0; SPSS Inc., Chicago, IL, USA) with the level of significance set at 0.05. As the data were metric continuous, the mean, standard deviation, and range of tooth dimensions for boys, girls, and combined sample were tabulated. Shapiro–Wilk test revealed normality of the data; hence, the difference in tooth dimensions between boys and girls was tested using unpaired t test, while contra lateral teeth were compared using paired t test. The correlation between actual and predicted values in boys and girls was performed using Pearson’s correlation test, whereas, the validity was tested using paired t test.


  Results Top


When dimensions of teeth in boys and girls were compared, boys showed larger teeth than girls, which were all statistically significant. No statistical difference between contra lateral sides was observed, except for maxillary second premolar and mandibular lateral incisor in girls; left side showing greater values [Table 1].
Table 1: Mesio-distal widths of contralateral teeth in boys and girls

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On correlating the actual MDWs of C and Ps with the predicted values obtained using TJ and Moyers’ analyses, in maxilla and mandible, moderate positive correlations were observed in both boys and girls, which were all statistically significant [[Table 2]a and [Table 2]b]. However, on using paired t test, a statistically significant difference was observed between the actual MDWs of C and Ps and those calculated using TJ method. Similarly, estimations based on Moyers’ analysis at both 35 and 75% probability levels also showed a significant difference. On observing the comparisons with Moyers’ 50% level, no significant difference in boys, for both maxillary and mandibular arches was noticed; whereas, in girls, significant difference was observed. On the other hand, predictive values at Moyers’ 65% level in the maxillary arch showed non-significant difference among girls and significant difference among boys; whereas in mandibular arch, significant difference was observed among both boys and girls [Table 3].
Table 2: (a) Correlation of maxillary actual canine and premolar dimensions with those predicted using Tanaka–Johnston and Moyers’ mixed dentition analysis. (b) Correlation of mandibular actual canine and premolar dimension with those predicted using Tanaka–Johnston and Moyers’ mixed dentition analysis

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Table 3: Comparison of maxillary and mandibular canine and premolar dimensions with those predicted using Tanaka–Johnston and Moyers’ mixed dentition analysis

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  Discussion Top


MDA is one among the routine investigations employed in pediatric dentistry, for which Moyers’ and TJ analyses are utilized in the clinical practice. Both these analyses were derived from population of North European descent and were proven to be unreliable in populations of various ethnic backgrounds.[18],[21],[28],[29] The influence of changing secular trends also demands a revision or validation of population-based statistics, at least once in every generation, which is approximately 30 years.[10] Hence, the present study was planned to assess the applicability of these analyses to South Andhra Pradesh (Southeast India) population.

To determine the gender differences, tooth dimensions of boys and girls were compared; boys showed significantly larger teeth than girls as reported previously.[2],[3],[11],[18],[21] Another confounding factor that can influence the tooth dimensions is the arch segment (right/left), which was also considered for the target population. A significant difference was observed in maxillary second Ps and mandibular lateral incisors between contra lateral segments among girls. This is in contrast to the findings of some studies reported,[21] which observed no significant difference between dimensions of contra lateral teeth. Hence, all further comparisons in the present study were performed separately for right and left segments, in both boys and girls.

TJ analysis has been proved to be inaccurate for the present population, as it has overestimated the dimensions of C and Ps. This is in accordance with most of the studies conducted on various populations all over the world.[8],[11],[16],[18] Similar findings were also reported by some of the Indian studies.[1],[23],[28],[30],[31],[32],[33],[34] On the other hand, few studies[20] showed underestimation of TJ analysis and one study proved it applicable for their population, which the authors mentioned as coincidental.[22]

The applicability of Moyers’ analysis also has been tested worldwide with studies performed on Arabian,[11] Brazilian,[2] Chinese,[12] German,[13] Nepalese,[14] Peruvian,[15] Senegalese,[16] Italian,[17] Iranian,[18] Pakistani,[19] Jordanian,[20] Thai,[22] Turkish,[21] Ugandan,[8] and Malaysian[9] populations. These studies showed wide variability in the applicability of Moyers’ at various percentiles. In studies conducted on Indian population,[23],[24],[26],[31],[33],[35] validity of Moyers’ analysis at 35, 50, 65, or 75% probability levels has been proven. Hence, in the present study all these percentiles were considered for comparison in the target population, which revealed overestimation of tooth dimensions with Moyers’ at 75% level and underestimation with 35% level. The predictive values at Moyers’ 50% level showed a nearly reliable estimate for boys and 65% for girls only in the maxillary arch. The Indian studies available reported mixed findings; a study conducted on Himachal population[24] observed inaccuracy of Moyers’ at all percentiles, while, accuracy with all the percentiles was reported in a study on Nalgonda population.[31] Contrarily, another study conducted on Nalgonda population[35] reported Moyers’ at 75% probability level as a more reliable estimate. Studies conducted on Bengali[23] and Chennai[33] populations reported Moyers’ 50% level as realistic estimate when compared to the recommended 75% level, whereas a study conducted on Central Indian population[26] reported Moyers’ 50 and 65% levels for girls and boys respectively in the maxillary arch, and 35% level for mandibular arch, irrespective of the gender. A study on South Indian population[26] reported Moyers’ 35% level to be more reliable which is in contradiction to the finding of the present study.The major limitation of the studies conducted to test the validity of established methods such as Moyers’ and TJ is generalizability of the findings to other populations. Thus, the results can be applied only for the considered population, which emphasizes on the necessity to formulate population specific regression equations.


  Conclusion Top


  1. TJ method and Moyers’ method at 35 and 75% probability level could not be applied for the considered population. For boys, Moyers’ at 50% level was better applicable, whereas, for girls Moyers’ at 65% level was applicable only for maxilla.
  2. Hence, population-specific new regression equations have to be formulated to accurately predict the size of un-erupted C and Ps.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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