IAO Article Library
Evaluation of Tooth Size Discrepancy and Bolton Tooth Size Analysis in Different Angle’s Malocclusion Groups: A Retrospective Study
Record ID: 543
DOI: http://doi.org/10.67782/UXBZ9957
ISSN: 1539-1450
Primary Author: Ebrahimi, Hossein
Additional Authors: Vaziri, Abbas Salehi
Affiliations: Department of Orthodontics, School of Dentistry, Shahed University of Medical Sciences, Tehran, Iran
Abstract:
Background and aim: The tooth size discrepancy (TSD) is crucial in determining and predicting treatment outcomes. The Bolton analysis, which measures the mesiodistal width of the mandibular and maxillary teeth, is essential for this process. This study aims to evaluate the Bolton anterior and overall tooth size ratios and to analyze their association with various classes of dental malocclusion, as defined by Angle’s classification. Methods: In this retrospective cross-sectional study, 150 patients with complete permanent dentition and no dental anomalies were randomly selected. After excluding unsuitable casts, samples were divided into Class I, II, and III malocclusion groups. Anterior and overall Bolton ratios were measured and analyzed across groups, and gender differences were also evaluated. Results: The present study showed that skeletal Class III patients had significantly higher anterior Bolton ratios than Class II patients. However, this difference was not statistically significant in the CLI group, although it was greater. Although the differences in overall Bolton ratios between different malocclusion groups were not statistically significant. Statistical analysis showed that there was a weak correlation between these parameters and anterior Bolton ratios. About 30% of patients had significant anterior tooth size differences (more than 1 standard deviation from the Bolton standard). In this study, there was no significant difference in anterior and overall Bolton ratios between the male and female groups. Conclusion: This study revealed that skeletal Class III patients had a significantly higher anterior Bolton ratio than Class II patients. There was no significant difference in overall Bolton ratios between different malocclusion groups, and there was no significant difference in anterior and overall Bolton ratios between males and females in general.
Bibliography:
1. Zhang G, Feng Q, Wei X, Xing K, Mei H, Zhou J, et al. A simple method for quick evaluation of the anterior tooth ratio: an observational study. BMC Oral Health. 2022;22(1):495. doi:10.1186/s12903-022-02517-3.
2. Bhayya DP, Shyagali TR, Dixit UB, Shivaprakash. Study of occlusal characteristics of primary dentition and the prevalence of maloclusion in 4 to 6 years old children in India. Dent Res J (Isfahan). 2012;9(5):619-23. doi:10.4103/1735-3327.104883.
3. Prasanna AL, Venkatramana V, Aryasri AS, Katta AK, Santhanakrishnan K, Maheshwari U. Evaluation and Comparison of Intermaxillary Tooth Size Discrepancy among Class I, Class II Division 1, and Class III Subjects Using Bolton’s Analysis: An in vitro Study. J Int Oral Health. 2015;7(9):58-64.
4. Vorloeper J, Coenen FA, Lang NA, Niederau C, Knaup I, Craveiro RB, et al. Digital analyses of Bolton tooth size ratios and their association to gender, angle class, and other occlusal traits: a study using a partially automated digital 3D model analysis. Eur J Orthod. 2024;46(5). doi:10.1093/ejo/cjae046.
5. Babu CL, Sunil T, Rani MS. Survey on Bolton’s Tooth Size Analysis as Applied to Artificial Teeth. J Indian Prosthodont Soc. 2010;10(4):200-2. doi:10.1007/s13191-011-0047-z.
6. Turtinen H, Sarja M, Hyvärinen J, Pirhonen P, Pesonen P, Pirttiniemi P, et al. Associations between Bolton ratio and overjet deviations in a Finnish adult population. Acta Odontol Scand. 2021;79(8):593-9. doi:10.1080/00016357.2021.1918348.
7. Ebadifar A, Taliee R. Comparison of Bolton’s Ratios before and after Treatment in an Iranian Population. J Dent Res Dent Clin Dent Prospects. 2013;7(1):30-5. doi:10.5681/joddd.2013.005.
8. Ajami S, Fattahi H, Zare M, Jenabi P. Bolton discrepancy in an Iranian population and its relation with maxillary lateral incisors’ size. Electronic Physician. 2018;10(3):6454.
9. Sharma R, Kumar S, Singla A. Prevalence of tooth size discrepancy among North Indian orthodontic patients. Contemporary clinical dentistry. 2011;2(3):170-5.
10. Marañón-Vásquez GA, Vieira AR, Dos Santos LV, Cunha AS, Weiss SG, Araujo MTS, et al. FGF10 and FGF13 genetic variation and tooth-size discrepancies. Angle Orthod. 2021;91(3):356-62. doi:10.2319/060920-531.1.
11. Dagdiya MS, Kumari L, Motarwar AN, Richashree, Anand K, Prakash S. An Assessment of the Correlation Between Tooth Size and Agenesis of Maxillary Lateral Incisor in Subjects Undergoing Orthodontic Treatment. Cureus. 2022;14(6):e25642. doi:10.7759/cureus.25642.
12. Saghiri MA, Eid J, Tang CK, Freag P. Factors influencing different types of malocclusion and arch form-A review. J Stomatol Oral Maxillofac Surg. 2021;122(2):185-91. doi:10.1016/j.jormas.2020.07.002.
13. Jabri MA, Wu S, Zhang Y, Ma J, Wang L. A Review on Comparison of Tooth Size Discrepancies among Angle’s Class I, II, and III Malocclusion: Is There a Significance? J Contemp Dent Pract. 2019;20(8):994-9.
14. Wang M, Huang J, Tang X, Zheng L, Yang C. Anterior alveolar bone and tooth inclination in different skeletal patterns: a cone-beam computed tomography study. BMC Oral Health. 2025;25(1):1210. doi:10.1186/s12903-025-06537-7.
15. Aktürk ES, Müftüoğlu Ö, Memikoğlu TUT. Anterior Tooth Size Discrepancy in Class III Surgical Patients. Turkish Journal of Orthodontics. 2022;35(3):186.
16. Alsaigh H, Alrashdi M. Geometric analysis of tooth size among different malocclusion groups in a Hispanic population. Am J Orthod Dentofacial Orthop. 2023;164(5):646-56. doi:10.1016/j.ajodo.2023.03.022.
17. Abd Rahman ANA, Othman SA, Marya A. Measuring tooth size discrepancies using Bolton analysis: a comparative cross-sectional study among major ethnicity in Malaysia. BMC Oral Health. 2023;23(1):534. doi:10.1186/s12903-023-03185-7.
18. Leung EMY, Yang Y, Khambay B, Wong RWK, McGrath C, Gu M. A Comparative Analysis of Tooth Size Discrepancy between Male and Female Subjects Presenting with a Class I Malocclusion. ScientificWorldJournal. 2018;2018:7641908. doi:10.1155/2018/7641908.
19. Rakhshan V, Ghorbanyjavadpour F, Ashoori N. Buccolingual and Mesiodistal Dimensions of the Permanent Teeth, Their Diagnostic Value for Sex Identification, and Bolton Indices. BioMed Research International. 2022;2022(1):8381436. doi:https://doi.org/10.1155/2022/8381436.
20. Guarnieri R, Squillace F, Podda R, Monterossi AS, Galluccio G, Di Giorgio R, et al. Three-Dimensional Dental Analysis in Subjects with Skeletal Malocclusion: A Retrospective Observational Study. Dent J (Basel). 2025;13(7). doi:10.3390/dj13070280.
21. Othman SA, Harradine NWT. Tooth-size discrepancy and Bolton’s ratios: a literature review. Journal of orthodontics. 2006;33(1):45-51.
22. Tejani SS, Parameswarappa P, Mallikarjuna K, Nagaveni N, Roopa K, Eregowda NI. Effect of intermaxillary tooth-size discrepancy on accuracy of prediction equations for mixed dentition space analysis for Davangere population. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2022;40(2):146-53.
23. Bind P, Doshi J, Gandhi P, Faliya N, Mathakiya L. Comparision of maxillomandibular tooth size discrepancy among different malocclusion groups in Saurashtra population.
24. Teixeira Santana T, Copello F, Marañón-Vásquez GA, Issamu Nojima L, Franzotti Sant’Anna E. Diagnostic performance of ClinCheck, Dolphin Imaging, and 3D Slicer software for Bolton discrepancy analysis. Angle Orthod. 2025;95(1):51-6. doi:10.2319/022724-156.1.
25. Celikoglu M, Nur M, Kilkis D, Sezgin OS, Bayram M. Mesiodistal tooth dimensions and anterior and overall Bolton ratios evaluated by cone beam computed tomography. Aust Orthod J. 2013;29(2):153-8.
26. Jaber ST, Hajeer MY, Alkhouli KW, Al-Shamak RM, Darwich KMA, Aljabban O, et al. Evaluation of Three-Dimensional Digital Models Formulated From Direct Intra-oral Scanning of Dental Arches in Comparison With Extra-oral Scanning of Poured Dental Models in Terms of Dimensional Accuracy and Reliability. Cureus. 2024;16(2):e54869. doi:10.7759/cureus.54869.
27. Nguyen TP, Ahn J-H, Lim H-K, Kim A, Yoon J. Automated Measurements of Tooth Size and Arch Widths on Cone-Beam Computerized Tomography and Scan Images of Plaster Dental Models. Bioengineering. 2025;12(1):22.
28. Kim J, Lagravére MO. Accuracy of Bolton analysis measured in laser scanned digital models compared with plaster models (gold standard) and cone-beam computer tomography images. Korean J Orthod. 2016;46(1):13-9. doi:10.4041/kjod.2016.46.1.13.
29. Alrasheed WA, Owayda AM, Hajeer MY, Khattab TZ, Almahdi WH. Validity and Reliability of Intraoral and Plaster Models’ Photographs in the Assessment of Little’s Irregularity Index, Tooth Size-Arch Length Discrepancy, and Bolton’s Analysis. Cureus. 2022;14(3):e23067. doi:10.7759/cureus.23067.
30. Loma Salcedo H, Huasco Huarcaya NE. [Degree of reliability of the assessment of the Bolton analysis in three-dimensional virtual models versus plaster models. a review]. Rev Cient Odontol (Lima). 2023;11(2):e155. doi:10.21142/2523-2754-1102-2023-155.
31. Zilberman O, Huggare JA, Parikakis KA. Evaluation of the validity of tooth size and arch width measurements using conventional and three-dimensional virtual orthodontic models. Angle Orthod. 2003;73(3):301-6. doi:10.1043/0003-3219(2003)073<0301:Eotvot>2.0.Co;2.
32. Omar H, Alhajrasi M, Felemban N, Hassan A. Dental arch dimensions, form and tooth size ratio among a Saudi sample. Saudi Med J. 2018;39(1):86-91. doi:10.15537/smj.2018.1.21035.
33. Machado V, Botelho J, Mascarenhas P, Mendes JJ, Delgado A. A systematic review and meta-analysis on Bolton’s ratios: Normal occlusion and malocclusion. Journal of Orthodontics. 2020;47(1):7-29.
34. Shahid F, Alam MK, Khamis MF. Intermaxillary tooth size discrepancy in a Pakistani population: A stereomicroscope versus digital caliper. European Journal of Dentistry. 2016;10(02):176-82.
35. Smith SS, Buschang PH, Watanabe E. Interarch tooth size relationships of 3 populations: “does Bolton’s analysis apply?”. Am J Orthod Dentofacial Orthop. 2000;117(2):169-74. doi:10.1016/s0889-5406(00)70228-9.
36. Uysal T, Sari Z. Intermaxillary tooth size discrepancy and mesiodistal crown dimensions for a Turkish population. Am J Orthod Dentofacial Orthop. 2005;128(2):226-30. doi:10.1016/j.ajodo.2004.04.029.
37. Mohammad MG, Din SN-u, Khamis AH, Athanasiou AE. Overall and anterior tooth size ratios in a group of Emiratis. The open dentistry journal. 2018;12:655.
38. Alshahrani AA, Alshahrani I, Addas MK, Shaik S, Binhomran FM, AlQahtani J. The Tooth Size Discrepancy among Orthodontic Patients and Normal Occlusion Individuals from Saudi Arabia: A Three-Dimensional Scan Analysis of Diagnostic Casts. Contemp Clin Dent. 2020;11(2):141-9. doi:10.4103/ccd.ccd_455_19.
39. Roy P, Roy P, Koley S, Sheet S. Bolton’s ratio variations in Angle’s Class I, Class II and Class III malocclusions: An observational study. J Clin Exp Dent. 2025;17(3):e280-e5. doi:10.4317/jced.62591.
40. Hanna A, Ellis III E. Tooth-size discrepancies in patients requiring mandibular advancement surgery. Journal of Oral and Maxillofacial Surgery. 2016;74(12):2481-6.
41. Mollabashi V, Soltani MK, Moslemian N, Akhlaghian M, Akbarzadeh M, Samavat H, et al. Comparison of Bolton ratio in normal occlusion and different malocclusion groups in Iranian population. Int Orthod. 2019;17(1):143-50. doi:10.1016/j.ortho.2019.01.005.
42. Daniel SB, Wiesen C, Christensen J, Frazier-Bowers SA. Using a digital platform to establish odontometric variation based on race, gender and Angle classification. Orthod Craniofac Res. 2023;26 Suppl 1:204-9. doi:10.1111/ocr.12664.
43. Alqahtani AS, Habib SR, Ali M, Alshahrani AS, Alotaibi NM, Alahaidib FA. Maxillary anterior teeth dimension and relative width proportion in a Saudi subpopulation. J Taibah Univ Med Sci. 2021;16(2):209-16. doi:10.1016/j.jtumed.2020.12.009.
44. Wang Y, Song Y, Zhong Q, Xu C. Evaluation of influence factors on the width, length, and width to length ratio of the maxillary central incisor: A systematic review and meta-analysis. J Esthet Restor Dent. 2021;33(2):351-63. doi:10.1111/jerd.12606.
45. Awawdeh M, Alsaadi W, Alraddadi FAB, Alshunaiber R, Alessa J, Alsaeed S. Evaluation of the anterior and overall tooth ratios in the Saudi population versus Bolton’s standards. Front Pediatr. 2023;11:1237137. doi:10.3389/fped.2023.1237137.
46. Hussein FA, Mohamed RE, El-Awady AA, Ali MM, Al-Khalifa HN, Abdallah KF, et al. Digital evaluation of Bolton’s tooth size discrepancies among different malocclusions categories of Egyptian adolescent orthodontic population: A retrospective study. International Orthodontics. 2022;20(3):100660.
47. Mishra RK, Kafle D, Gupta R. Analysis of Interarch Tooth Size Relationship in Nepalese Subjects with Normal Occlusion and Malocclusions. Int J Dent. 2019;2019:2761427. doi:10.1155/2019/2761427.
48. Awawdeh M, Alsaadi W, Alraddadi FAB, Alshunaiber R, Alessa J, Alsaeed S. Evaluation of the anterior and overall tooth ratios in the Saudi population versus Bolton’s standards. Frontiers in Pediatrics. 2023;11:1237137.
49. Cappellozza JA, Guedes FP, Nary Filho H, Capelozza Filho L, Cardoso Mde A. Orthodontic decompensation in skeletal Class III malocclusion: redefining the amount of movement assessed by Cone-Beam Computed Tomography. Dental Press J Orthod. 2015;20(5):28-34. doi:10.1590/2177-6709.20.5.028-034.oar.
50. García-Gil M, Alarcón JA, Cacho A, Yañez-Vico R, Palma-Fernández JC, Martin C. Association between Eruption Sequence of Posterior Teeth, Dental Crowding, Arch Dimensions, Incisor Inclination, and Skeletal Growth Pattern. Children (Basel). 2023;10(4). doi:10.3390/children10040674.