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ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 4  |  Page : 553-557

Comparison of mesiodistal tooth width in individuals from three ethnic groups in Southern Saudi Arabia


1 Department of Pediatric Dentistry and Orthodontic Sciences (POS), College of Dentistry King Khalid University, Abha, Kingdom of Saudi Arabia
2 Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia

Date of Acceptance28-Dec-2018
Date of Web Publication11-Apr-2019

Correspondence Address:
Dr. M Zakirulla
Assistant Professor, Department of Pediatric Dentistry and Orthodontic Sciences (POS), Division of Pedodontics, College of Dentistry, King Khalid University, Guraiger, P. O. BOX - 3263, Abha - 61471
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_593_18

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   Abstract 


Objective: The aim of this study was to compare the mesiodistal tooth sizes and to see the gender dimorphism among three ethnic groups of southern part of Saudi Arabia, that is, Asir, Najran, and Jizan region. Subjects and Methods: The sample composed of 90 individuals (45 of each gender) from 3 different regions of southern Saudi Arabia, having mean age of 26.9 years. The measurements were done directly on the models with the aid of the digital calliper measuring the largest mesiodistal measure of incisors, canines, premolars, and molars in both sides. Results: Almost all the mesiodistal tooth widths were statistically significant between the groups except maxillary and mandibular permanent third molars. Regarding sexual dimorphism, the groups were combined; almost all the mesiodistal tooth widths were not shown statistically significant difference between the males and females except that right first permanent premolars were significantly larger in the females than in the males. Conclusion: The present study has provided norms of the mesiodistal permanent tooth diameters of a Saudi population that are newer and more complete than the previously published norms. There appear to be some secular trends in the mesiodistal diameter of the Saudi permanent teeth toward sexual dimorphism.

Keywords: Dental cast, dentition, digital caliper, mesiodistal width, Saudi Arabia


How to cite this article:
Togoo R A, Alqahtani W A, Abdullah E K, A Alqahtani A S, AlShahrani I, Zakirulla M, Alhotellah K A, Mujam O H. Comparison of mesiodistal tooth width in individuals from three ethnic groups in Southern Saudi Arabia. Niger J Clin Pract 2019;22:553-7

How to cite this URL:
Togoo R A, Alqahtani W A, Abdullah E K, A Alqahtani A S, AlShahrani I, Zakirulla M, Alhotellah K A, Mujam O H. Comparison of mesiodistal tooth width in individuals from three ethnic groups in Southern Saudi Arabia. Niger J Clin Pract [serial online] 2019 [cited 2019 Apr 22];22:553-7. Available from: http://www.njcponline.com/text.asp?2019/22/4/553/255937




   Introduction Top


The task of an orthodontist is to align the teeth to improve masticatory efficiency, facial esthetics, and alignment of the dental arches, which is frustrated by the presence of crown-size discrepancies.[1] This can affect the treatment process and may ultimately complicate cases. It is essential for the clinician to know the sizes of individual teeth and groups of teeth to make an accurate diagnosis, determine an appropriate treatment plan, ensure stable interdigitation, and accurately predict orthodontic treatment outcomes.[2],[3] Well-indicated and functionally adjusted tooth contouring and reshaping can provide satisfactory results. Esthetic restoration has a major psychological effect for edentulous patients; once esthetics are properly restored, self-esteem and self-confidence are often improved, which is one of the goals of oral rehabilitation treatment.[4] Population-specific norms of permanent tooth size are useful resources for orthodontists and pedodontists in space analysis, prediction, interception, and treatment of space-related malocclusion problems such as teeth crowding. Population and sex-specific data on tooth dimensions are also highly valuable for anthropologists and forensic odontologists.[5]

The mesiodistal tooth sizes of the maxillary and mandibular arches should be balanced to ensure appropriate interdigitation, overbite, and overjet at the completion of orthodontic treatment.[6] The variability of permanent tooth size is influenced by genetic and environmental factors, such as race, sex, heredity, environment, secular changes, and bilateral asymmetry.[7] Environmental variables, such as nutrition, disease, and climate, affect dentition during the prenatal period but seem to exert little influence on normal dental variation.[8]

Knowledge of the average mesiodistal width will help in obtaining satisfactory treatment outcomes. Differences in tooth size have been associated with different ethnic backgrounds and malocclusion types.[9] The majority of research has been conducted with the aim of understanding the relationship between types of malocclusion and the size of teeth and to compare it to the jaw size.[10] To the best of the author's knowledge, very few publications have reported mesiodistal tooth diameters in Saudi Arabia. Thus far, the literature contains no studies on the measurement of mesiodistal tooth width in southern Saudi Arabia. Data on tooth sizes for the relevant ethnic, sex, and malocclusion groups are necessary before a tooth can be determined as undersize or oversize.[11] To improve the quality of dental care available, data are urgently required on the mesiodistal crown dimensions of individual permanent teeth in the Saudi population. The objectives of the present study were to compare mesiodistal tooth sizes and assess gender dimorphism among three ethnic regions of southern Saudi Arabia (Asir, Najran, and Jizan).


   Subjects and Methods Top


The sample comprised 90 patients (45 of each sex) from 3 different regions of southern Saudi Arabia, with a mean age of 26.9 years. The total sample was divided into 3 groups: 30 patients from the Asir region (Group A, 15 of each sex), 30 patients from the Najran region (Group B, 15 of each sex), and 30 patients from the Jizan region (Group C, 15 of each sex). The average ages of the patients from whom the data were collected were 23.3, 33.3, and 24.1 in Groups A, B, and C, respectively.

The criteria for selection of the sample were as follows:[12]

  1. Upper and lower permanent teeth in occlusion
  2. Good occlusion (angle class I relationship, with no crowding, open bite, or overbite)
  3. Absence of history of orthodontic treatment
  4. Absence of anomalous morphology or number of teeth
  5. Absence of history of extraction
  6. Absence of large restorations that could affect mesiodistal diameter
  7. Models in good condition
  8. Ethnicity verified by photographs and patient history obtained through a survey filled out by the patient or guardian.


Impressions of both maxillary and mandibular arches were made of the selected sample using irreversible hydrocolloid (alginate) impression material, which was filled immediately with green dental stone. The resulting study models were finished and polished. The models were measured directly with the aid of the digital calipers to determine the largest mesiodistal dimensions of the incisors, canines, premolars, and molars on both sides. The calipers were positioned parallel to the occlusal surface, by the buccal face, perpendicular to the long axis of the crown, to measure the tooth's largest mesiodistal dimension. Care was taken to include only fully erupted permanent teeth on both sides of the dental arches up to the third molars. The mesiodistal crown diameters of all dental casts were measured by one of the authors using digital calipers (Mitutoyo, Japan) within an accuracy of 0.05 mm. Each tooth was measured twice and the average of the two readings was used as the diameter for that tooth. If the two measurements differed by more than 0.25 mm, a third measurement was taken, and the two closest values were averaged.[13] This study was approved by the Ethical Committee of the College of Dentistry, King Khalid University, Abha.

Statistical analysis was performed using the Statistical Package for the Social Sciences (version 17). One-way analysis of variance was used to identify statistically significant differences among the groups and Tukey's post hoc analysis test was used to determine which groups were differed from one another. Independent t-tests were used to identify sex differences among the samples. The significance level was set at P < 0.05 for all statistical tests.


   Results Top


The sample comprised 90 patients (45 of each sex) from 3 different regions of southern Saudi Arabia, with a mean age of 26.9 years. The total sample was divided into 3 groups: 30 patients from the Asir region (Group A, 15 of each sex), 30 patients from the Najran region (Group B, 15 of each sex), and 30 patients from the Jizan region (Group C, 15 of each sex) [Table 1]. The average ages of the patients from whom the data were collected were 23.3, 33.3, and 24.1 years in Groups A, B, and C, respectively [Table 2]. [Table 3] presents the mean, standard deviation, and statistical significance of the mesiodistal dimension of maxillary and mandibular, and left and right permanent teeth compared among the three study groups. Almost all mesiodistal widths differed significantly among the groups except maxillary and mandibular permanent third molars. To investigate sexual dimorphism, the groups were combined. Data from the 45 men were compared with the data from the 45 women [Table 4], revealing that almost all mesiodistal widths showed no significant differences between the men and women except that right first permanent premolars were significantly larger in the women.
Table 1: Distribution of sample amount three groups

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Table 2: Distribution of individuals according to age and sex among different groups

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Table 3: Clinical parameter - mesiodistal dimension of maxillary and mandibular permanent teeth compared between three study groups

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Table 4: Clinical parameter - mesiodistal dimension of maxillary and mandibular permanent teeth compared between gender

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   Discussion Top


For the maxillary teeth to fit well with the mandibular teeth, there must be a definite proportionality of tooth size according to Bolton.[7] Tooth size, particularly mesiodistal width, is one of the fundamentals that orthodontists must consider. A major variation in this fit leads to malocclusion and difficulties in obtaining an occlusion with optimal overjet, overbite, and Class I canine and molar relation.[14]

Orthodontists should be aware of tooth size discrepancies before beginning orthodontic treatment. The mesiodistal tooth sizes of the maxillary and mandibular arches must relate to each other to obtain optimal occlusion at the completion of orthodontic treatment.[15] Tooth size discrepancy has been described as a relative excess of tooth structure in one arch in relation to the other arch. For appropriate alignment of the teeth, tooth size must complement arch size.[16] By identifying the individual variation in the mesiodistal tooth width of the maxillary permanent central incisor and the first molar, an orthodontist or dental surgeon can determine tooth size discrepancy in the maxillary arch, which is essential to diagnosis and treatment planning for orthodontic cases.[17]

The tooth size standards based on odontometric investigations can be used in age and sex determination. Most studies conducted in this area have not included Saudi Arabia, despite it having the largest population compared to other ethnic groups in the Middle East, and the literature contains very few studies on the measurement of tooth sizes in Saudi populations.[18],[19],[20],[21],[22] The present study was conducted to compare mesiodistal tooth sizes and assess gender dimorphism among three ethnic regions of southern Saudi Arabia.

In this study, the measurements were performed directly on the casts with digital calipers because measurements of study models have been proven to be more reliable than measurements performed directly in the mouth.[23] Thus, the mesiodistal distance of each tooth was determined as the largest distance between the tooth's mesial and distal faces, using a digital caliper positioned as parallel as possible to the occlusal surface by the tooth's buccal face.[16] Measuring the mesiodistal width of teeth can be difficult for researchers because of the tight contact between adjacent teeth and the lack of accessibility even when using calipers or dividers. Occasionally, maximum convexity does not coincide with the distance between the distal side and the mesial side. The young age of the patients in the present study had the advantage of reducing the occurrence of age-related changes that alter tooth morphology, such as tooth wear, fracture, and restoration, which increased the number of teeth suitable for measurement in each dental cast.

In the present study, the mean, standard deviation, and statistical significance of the mesiodistal dimensions of maxillary and mandibular, and left and right permanent teeth were compared among the three study groups. All of the mesiodistal widths differed significantly among the groups except maxillary and mandibular permanent third molars. The mesiodistal width in the maxillary arch was larger in men than in women, whereas the reverse was true for the mandibular arch but with no statistical significance except for right lower first premolar. This is in agreement with the results obtained by Alkofide[19] and Asiry[21] in Saudi populations. First molars having greater width than second molars are in accordance with the study of Richardson and Malhotra.[24] A previous study reported a statistically significant relationship between sex and the mean tooth size of most teeth, but no statistical significance in the relationship between sides.[25] Al-Tamimi and Hashim[20] also found no sexual dichotomy in Bolton's ratios in a relatively small sample of 65 Saudi patients. By contrast, another study reported that the men had larger Bolton's ratios than women.[26] A study by Hashim and Murshid[18] on Saudi men and women aged 13–20 years, conducted to determine the teeth in human dentition with the highest likelihood of dimorphism, revealed that only the canines in both jaws exhibited a significant sexual difference.

The present study was conducted to determine the mesiodistal width of permanent teeth in the maxillary and mandibular arch of patients from three ethnic regions of southern Saudi Arabia. Significant variation in mesiodistal width was observed among the three groups, but no variation was detected between male and female patients. In clinical practice, major benefits can be obtained by focusing on tooth size discrepancies between the maxillary and mandibular teeth. The present study provides norms of mesiodistal permanent tooth diameters for Saudi population that are more up-to-date and complete than those previously published. Secular trends toward sexual dimorphism were observed in the mesiodistal diameter of Saudi permanent teeth. These new norms can be used in various clinical disciplines of dentistry, in basic dental research, in forensic odontology, and in anthropological research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Rahman MA, Nasima B, Farzana F, Alam MK. Analysis of tooth size discrepancy (Bolton ratio) among orthodontic patient at Combined Military Hospital (CMH), Dhaka. Int Med J 2014;21:38-40.  Back to cited text no. 15
    
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Hashim HA, Murshid ZA. Mesiodistal tooth width. A comparison between Saudi males and females. Part 1. Egypt Dent J 1993;39:343-6.  Back to cited text no. 18
    
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Alkofide E, Hashim H. Intermaxillary tooth size discrepancies among different malocclusion classes: A comparative study. J Clin Pediatr Dent 2002;26:383-7.  Back to cited text no. 19
    
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Al-Tamimi T, Hashim HA. Bolton tooth-size ratio revisited. World J Orthod 2005;6:289-95.  Back to cited text no. 20
    
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Asiry M, Hashim H. Tooth size ratios in Saudi subjects with Class II, Division 1 malocclusion. JIOH 2012;4:29-34.  Back to cited text no. 21
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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