Orthodontic Space Analysis

SPACE ANALYSIS IN
ORTHODONTIC
D r. A M R E L D E S O U K Y
B.D.S., Morth RCSEd., Scotland-Uk
Member of the Royal College of Surgeons of Edinburgh
John MCD. Medal RCSEd-Uk
P. Member European Board of Orthodontics
STEPS TO A PROPER ORTHODONTIC DIAGNOSIS
1. PATIENT’S CHIEF COMPLAINT

2. DENTAL AND MEDICAL HISTORY
3. CLINICAL EXAMINATION
4. ORTHODONTIC RECORDS
IN occlusion
• Incisor relation
• Canine relation
• Molar relation
• Over jet
• Over bite
• Cross bite
• Dental midlines
Apart
• teeth present
• teeth absent
• arch form
• space analysis
SPACE ANALYSIS
Permanent dentition Mixed dentition
PERMANENT MIXED
q Carey’s analysis qRadiographic
q Ashley Howe’s analysis qMoyar’s Analysis
q Bolton’s analysis qTanaka & Johnson Analysis
q Peck & peck index
q Royal London space analysis
CARY’S SPACE ANALYSIS Calculating
Space available
CARY’S SPACE ANALYSIS Calculating
Space needed
c. Severe crowding >8mm b. Moderate crowding 4-8mm a. Mild crowding 0-4mm
WHY IS IT DIFFERENT !!!
The goal is to estimate the size of the un-erupted teeth
Two
methods
Measurements from Measurements from

Radiographic image Equations or table
prediction
RADIOGRAPHIC METHOD (PROP. EQUATION)
1. MD width erupted tooth on cast.
2. MD width (un-erupted tooth) &

(erupted tooth) on the same
radiograph.
RADIOGRAPHIC METHOD (PROP. EQUATION)
unerupted tooth (cast) = erupted tooth (cast) 8
unerupted tooth (x-ray) 9.6 erupted tooth (x ray) 9.1
Unerupted tooth width = 9.6 x 8 = 8.4 mm

9.1
MOYAR’S ANALYSIS
High correlation exists among the sizes of different groups
of teeth in an individual.
Measuring Prediction of
one group of another
teeth group
TANAKA & JOHNSON ANALYSIS
Repeated Moyer’s study, they developed an equation
using the MD width of the mandibular incisors.
Predicted width of maxillary 345 (per-side):
= (sum of mandibular incisor) + 11

2
TANAKA & JOHNSON ANALYSIS
Predicted width of mandibular 345 (per-side):
= ( sum of mandibular incisor )+ 10.510.5

2
BOLTON ANALYSIS
1. OVERALL RATIO:
sum of MD width of mandibular 12 teeth

X 100 = 91.3%
sum of MD width of maxillary 12 teeth
2. ANTERIOR RATIO:
sum of MD width of mandibular 6 teeth

X 100 = 77.2%
sum of MD width of maxillary 6 teeth
MD
If the
12=ratio
90mm,
is higher
Mx 12=
than96.5,
meanRatio
valueis excessive
93%
Mandibular value = (96.5) x 91.3 = 88.1mm
I.e. > 91.3% or > 77.2 100 % Mandibular excess
90 – 88.1= 1.9mm mandibular excess
Mandibular value = (Maxillary MD tooth width) x 91.3

100
If the ratio is lowerlthan mean value
MD 6 = 38mm, Mx 6 = 52mm, Ratio is 73%
Maxillary valueor
I.e. < 77.2% = <(38) x 100Maxillary
91.3% = 49.2mm excess
77.2
52 – 49.2= 2.8mm maxillary excess
Maxillary value = (Mandibular MD tooth width) x 100
77.2
ROYAL LONDON SPACE ANALYSIS
Do we only need space to align the teeth !!!!!
ROYAL LONDON SPACE ANALYSIS
o Developed in 1985 as a part of the post
graduate program in the Royal London hospital.
o Derived from Andrew’s six keys to normal

occlusion by assessing the space required and
any additional space to be created.
Aspects checked for SPACE NEEDED
1. Crowding / spacing
Recorded in +/-
2. Leveling the curve of Spee

For a 3mm curve = - 1mm
For a 4mm curve = - 1.5mm
For a 5mm curve = - 2mm
3. Arch width changes
Every 1mm of maxillary arch expansion = +0.7mm
Every 1mm of mandibular arch expansion = +0.37mm

4. Incisor A/P position
Every 1mm of overjet reduction = -2mm

5. Inclination/Angulation
Every 5º of retroclination for upper incisors = -1mm
Every 2.5º of retroclination for lower incisors = -1mm

5. Inclination/Angulation
Every 20º of angulation change for an upper

incisor = 0.25mm
Aspects checked for SPACE CREATED
1. Tooth reduction
2. Tooth enlargement
3. Extraction
4. Molar movement
ROYAL LONDON SPACE PLANNING FORM
Checking for space needed
1. Crowding / spacing =
2. Leveling the curve of Spee =
3. Arch width changes =
4. Incisor A/P position =
5. Inclination change =
6. Angulation change =
Aspects checked for space creatation
1. Tooth reduction =
2. Tooth enlargement =
3. Extraction =
4. Space opening =
COMPUTER AIDED SPACE ANALYSIS
ORTHO CADENT
Direct scan of the dentition, cast or
the scanning of an impression results
in a 3d digital study model
Enables the orthodontist to view,
manipulate, measure and analyze the
dentition through different diagnostic
tools
RADIOGRAPHS
A. INTRA-ORAL PERIAPICAL RADIOGRAPHS
Uses
a) Presence or absence of teeth
b) Root formation
c) Alveolar bone & PDL
d) Size/shape of unerupted
e) Axial inclination of roots
B. PANORAMIC RADIOGRAPHS
oA single image viewing of maxillary and mandibular

arches , dentition and their supporting structures
oUses !!
Localization of an impacted canine
using a panoramic radiograph
• According to Becker et al. in a single
panoramic radiograph, objects nearer x-ray
source project larger image than objects closer
to the film. So palatal canines will appear
larger.
Buccal
Palatal
C. CONE SHIFT TECHNIQUE
A periapical/bitewing is a 2d image that only

identifies vertical & horizontal positon of any object.
How can I determine the 3rd dimension !!!!
Tube shift (SLOB)

Clark’s law
Tube shift (SLOB)
Clark’s law
o Two films taken with horizontal or vertical

tube shift while the beam points in a
direction opposite to the cone shift
o Same Lingual Opposite Buccal

Same Lingual Opposite Buccal (Horizontal shift)
1 2
LOCALIZE BUCCO/LINGUAL POSITION OF

THE MAXILLARY LEFT 2 ND PREMOLAR !!!
Same Lingual Opposite Buccal (Vertical shift)
2
1
LOCALIZE THE FILLING !!!

Let’s give it a try
1 2
LOCALIZE BUCCO/LINGUAL POSITION OF THE

MANDIBULAR LATERAL INCISOR!!!
1 2

MAXILLARY LEFT CANINE !!!
2
1

MAXILLARY RIGHT LATERAL INCISOR!!!
2
1

MANDIBULAR RIGHT 2 ND PREMOLAR !!!
LOCALIZE BUCCO/LINGUAL POSITION OF THE MAXILLARY RIGHT
CANINE !!!
LOCALIZE BUCCO/LINGUAL POSITION OF THE MAXILLARY LEFT
CANINE !!!
LOCALIZE BUCCO/LINGUAL POSITION OF THE MAXILLARY RIGHT
CANINE !!!
D. TRUE OCCLUSAL RADIOGRAPHS
ForMax. the beam should be 110º to the OP.

while it should be 90º for the MD. view .
A true occlusal view will provide information in the
transverse & AP direction of an object .
E. CBCT RADIOGRAPHS
For
EXTRA-ORAL PHOTOGRAPHS

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SPACE ANALYSIS IN

1. PATIENT’S CHIEF COMPLAINT

Measurements from Measurements from

2. MD width (un-erupted tooth) &

Unerupted tooth width = 9.6 x 8 = 8.4 mm

Predicted width of maxillary 345 (per-side):

= (sum of mandibular incisor) + 11

Predicted width of mandibular 345 (per-side):

= ( sum of mandibular incisor )+ 10.510.5

sum of MD width of mandibular 12 teeth

sum of MD width of mandibular 6 teeth

Mandibular value = (Maxillary MD tooth width) x 91.3

o Derived from Andrew’s six keys to normal

2. Leveling the curve of Spee

3. Arch width changes

Every 1mm of maxillary arch expansion = +0.7mm

Every 1mm of mandibular arch expansion = +0.37mm

4. Incisor A/P position

Every 1mm of overjet reduction = -2mm

Every 5º of retroclination for upper incisors = -1mm

Every 2.5º of retroclination for lower incisors = -1mm

Every 20º of angulation change for an upper

oA single image viewing of maxillary and mandibular

A periapical/bitewing is a 2d image that only

How can I determine the 3rd dimension !!!!

Tube shift (SLOB)

o Two films taken with horizontal or vertical

o Same Lingual Opposite Buccal

LOCALIZE BUCCO/LINGUAL POSITION OF

LOCALIZE THE FILLING !!!

LOCALIZE BUCCO/LINGUAL POSITION OF THE

LOCALIZE BUCCO/LINGUAL POSITION OF THE

LOCALIZE BUCCO/LINGUAL POSITION OF THE

LOCALIZE BUCCO/LINGUAL POSITION OF THE

 ForMax. the beam should be 110º to the OP.

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ForMax. the beam should be 110º to the OP.