COMPARING OCCLUSAL ARCH FORM AND BASAL BONE ARCH

FORM USING CBCT IN BLACK, WHITE AND MEXICAN

AMERICAN MANDIBLES

Angela M. Williams, D.D.S.

An Abstract Presented to the Graduate Faculty of

Saint Louis University in Partial Fulfillment
of the Requirements for the Degree of
Master of Science in Dentistry

2013
 Abstract

Introduction: Relapse continues to be a concern for todays orthodontists. Prac-

titioners agree that stability is a goal of treatment but there are many views on

which method of treatment will produce the most stable result. A change in arch

shape, or form, from the pre-treatment shape has been suggested as a reason

for instability. The literature reports many factors that play into how the shape of

the arch is developed including muscles, periodontal fibers, function, genetics,

race, intercanine width, and keeping teeth within basal bone. Purpose: This

study looks at the arch shape at occlusal plane versus the arch shape at basal

bone to determine if there is any difference between the two levels. Materials

and Methods: Using the CBCT of 150 black, white and Mexican American pa-

tients slices were taken at occlusal plane and basal bone levels. A canine ratio

was calculated for each level. Shape was classified into ovoid, tapered and

square based on the mean and standard deviation of the canine ratio. Results:

No significant difference was found between the arch shapes at the two levels.

Ovoid was the shape seen in a majority of patients at both levels. Conclusions:

No significant difference was apparent between the arch shapes at occlusal

plane versus BB levels. No significant difference of arch shape distribution be-

tween males and females or among the black, white and Mexican Americans.

1
COMPARING OCCLUSAL ARCH FORM AND BASAL BONE ARCH

FORM USING CBCT IN BLACK, WHITE AND MEXICAN

AMERICAN MANDIBLES

Angela M. Williams, D.D.S.

A Thesis Presented to the Graduate Faculty of

Saint Louis University in Partial Fulfillment
of the Requirements for the Degree of
Master of Science in Dentistry

2013
COMMITTEE IN CHARGE OF CANDIDACY:

Associate Professor Ki Beom Kim,

Chairperson and Advisor

Assistant Clinical Professor Nick Azar

Associate Clinical Professor Donald R. Oliver

i
 DEDICATION

This work is dedicated to my wonderful husband, Donnie. You have done

nothing but encourage and support through this long road to change my career

path. You know how much I love you.

To my mom, Debbie, who listened to all of my heartaches and stresses

throughout this entire process. Thanks for being there.

Lastly, to the faculty of Saint Louis University, whose guidance and in-

struction have built a strong foundation for me to grow a fulfilling practice and fu-

ture.

ii
 ACKNOWLEDGEMENTS

This project was not possible without the help and support of the following

individuals:

Dr. Ki Beom Kim. Thank you for your guidance during my thesis preparation

and for enriching my education with your help and guidance in the classroom as

well as the clinic.

Dr. Rolf Behrents. Thank you for your contributions to my thesis and allowing

me to obtain an orthodontic education at Saint Louis University.

Dr. Donald Oliver. Thank you for your attention to detail during my thesis

preparation and revisions. The value of your clinical guidance cannot be meas-

ured.

Dr. Nick Azar. Thank you for taking the time to assist in the thesis progres-

sion and for contributing to my clinical education.

Dr. Peter Buschang. Thank you for helping me develop this thesis topic and

your meaningful contribution to my clinical education.

Dr. Derik Ure and Dr. Joe Mayes. Thank you for the use of your long-term

records in this study.

Dr. Heidi Israel. Thank you for your assistance with the statistical analysis for

this thesis.

iii
 TABLE OF CONTENTS
List of tables ......................................................................................................... v

List of figures ........................................................................................................ vi

CHAPTER 1: INTRODUCTION ............................................................................ 1

CHAPTER 2: REVIEW OF THE LITERATURE

Basal bone ..................................................................................... 5
Orthodontic stability and relapse.................................................... 7
Basal bone ............................................................................... 7
Orthodontic forces .................................................................... 8
Mandibular incisors .................................................................. 8
Intercanine width ...................................................................... 9
Race and ethnicity .................................................................. 10
Genetics versus environment ................................................. 11
Aging ...................................................................................... 11
Other factors........................................................................... 12
Mandibular arch form ................................................................... 12
Commercial wires ................................................................... 13
Race and ethnicity .................................................................. 13
Frequency of form .................................................................. 15
Intercanine width .................................................................... 15
Mathematical representation of arch form .............................. 17
Cone Beam Computed Tomography ........................................... 17
Statement of thesis ...................................................................... 20
Literature Cited ............................................................................ 22

CHAPTER 3: JOURNAL ARTICLE

Abstract ....................................................................................... 31
Introduction .................................................................................. 32
Materials and methods ................................................................ 35
Sample ................................................................................... 35
Cone Beam Computed Tomography (CBCT) technique ........ 36
Error study .............................................................................. 41
Statistical analysis .................................................................. 42
Results ......................................................................................... 44
Discussion ................................................................................... 45
Conclusion ................................................................................... 48
Literature Cited ............................................................................ 49

Vita Auctoris ....................................................................................................... 52

iv
 LIST OF TABLES

Table 3.1 Calculation of the canine ratio for OP and BB level based on the
digitized landmarks from Dolphin Imaging .................................... 43

Table 3.2 Calculation of the mean and standard deviation for the
canine ratios at the occlusal and BB level. One STD above
and below was calculated in order to classify the shape as
ovoid, square or tapered ............................................................... 44

Table 3.3 Distribution of shape across N=300.

Ovoid is the majority shape ........................................................... 45

v
 LIST OF FIGURES

Figure 3.1 Example of plotted points for occlusal plane slice

In Mexican male ............................................................................ 37

Figure 3.2 Example of Mexican male occlusal plane measurements ............. 38

Figure 3.3 Example of B point landmark in Mexican female........................... 39

Figure 3.4 Example of plotted points for basal bone slice

in white female .............................................................................. 40

Figure 3.5 Example of Mexican male BB measurements ............................... 41

Figure 3.6 Example of black female graph ..................................................... 42

vi
 CHAPTER 1: INTRODUCTION

Orthodontic relapse is a major concern in today's practice. One famous quote

by Dr. Hawley states he was willing to give one half of his fee to whomever could

retain his patients.1 It has been shown in animal studies that relapse begins im-

mediately after teeth are left unrestrained.2 Practitioners agree that stability is a

goal of orthodontic treatment but there are many views on which method of

treatment will produce the most stable result. Tweed, Brodie and Nance all

agreed that stability relates to basal bone.3-5 Peck and Peck argued that if the

shape of the anterior teeth was disproportional based on a ratio of mesio-distal

versus bucco-lingual width there would be relapse and suggested the need for

interproximal reduction in order to make the tooth shape more favorable. 6 Strang

argued that intercanine width was key to stability.7 The following paragraphs will

discuss several factors mentioned to attempt to define how an arch form devel-

ops and why relapse happens.

There are perioral factors such as pressure from muscles, lips, cheeks or

habits such as musical instruments to describe how the arch form develops.

Many authors have stated the orbicularis oris, mentalis, buccinator, and tongue

dictate arch form and tooth position.8-12 One book discusses how the lower inci-

sor position can lead to remodeling of the bone but that is not the only tissue to

consider since the teeth may be in bone but be periodontally compromised or out

of equilibrium with the oral cavity muscles.12 Burstone and Marcotte continue by

stating the dual muscular components of the orbicularis oris could place pressure

1
on the lower incisors only, upper incisors only or both.12 The buccinator influ-

ences the posterior width and the canines can behave like posterior teeth if the

oral slit is mesial to the canine allowing the cheek to apply more pressure than

the lips to the canines.12 There is disagreement on whether or not playing an in-

strument affects the position of incisors as one study concluded that for an indi-

vidual patient the effect of an instrument is unpredictable and should not be sub-

stituted for orthodontic treatment13 while another study said playing an instrument

can serve as an adjunct to orthodontic tooth movements. 14 Engelman studied

several types of habit-induced pressures and concluded thumb-sucking produced

the highest pressures, swallowing and whistling produced the lowest, and in-

strument playing lay in between with brass instruments and the flute having some

influence.15

There are anatomical factors to describe the development of the arch such as

divergence of the mandible to cranial base, memory of periodontal fibers or ge-

netic/racial influence. It has been shown that the attachment of periodontal fibers

is not determined by tooth anatomy but by the tooth position and orientation in

the arch16 and that a fibrotomy following orthodontic treatment may decrease the

amount of rotational relapse.17 Little et al. studied children in a rural Mexico vil-

lage over a 32-year period and showed the cranial complex remodeled to a

shorter head length and a narrower face.18 The study attributed these changes to

a decrease in food coarseness leading to a decrease in masticatory muscle func-

tion.18 Horner et al. built upon this research to study how mandibular plane angle

relates to bone development. The study described how mandibular cortical bone

2
thickness differs between hyperdivergent (patients that have a large facial diver-

gence and weaker muscle activity) and hypodivergent (patients that have a small

facial divergence and stronger muscle activity) individuals and concluded cortical

bone tends to be thicker in hypodivergent patients leading to a difference in alve-

olar ridge thickness.19 It has been shown that arch length and mandibular inter-

canine width both decrease over time as part of the natural aging process. 20

Orthodontic factors that relate to arch form include pre-treatment arch form,

intercanine width, incisor irregularity and keeping teeth within basal bone. Main-

taining the pre-treatment arch form has been suggested by some practitioners as

a key to stable orthodontic results.21 Keeping the patients arch form while

straightening the teeth might make the end result less likely to relapse.22 There is

a limit to the change in posterior width, and particularly intercanine width, that

can be achieved and remain stable.12 Ball et al. argued there is a different inter-

canine width between dental and basal arches but that it was unlikely to affect

the arch form as it was only 0.8 mm.23 Incisor irregularity occurs in almost every-

one with roughly 50% of untreated adults having little to none and the remaining

50% having moderate to severe.24 Buschang and Shulman concluded that incisor

crowding was multifactorial and included ethnicity, number of first and second

molars, sex and age combined.24 Several studies have shown there is an ana-

tomical difference between whites, blacks and Mexicans. Garcia showed bimaxil-

lary prognathism was seen more in Mexicans than whites,25 Buschang and

Shulman showed Mexicans have more lower incisor irregularity than whites, 24

and Bishara et al. showed Mexicans have larger tooth sizes than whites.26 Stud-

3
ies have shown that blacks have arches with wider mandibular posterior seg-

ments than whites or Hispanics and Hispanics have larger anterior ratios than

blacks.27, 28 With anatomical differences such as these one may expect that the

underlying bone is different between the three groups as well which may lead to

differences in the arch form distribution among the three groups.

Several authors believe that stability relates to keeping the original arch form

while maintaining the teeth over the underlying bone.3, 4, 7, 29 Basal bone has

been difficult to define4 so there is no one method of treatment that will ensure

stability. One could argue that arch form does not matter or that basal bone is not

definable.

If the arch shape is the same at the level of basal bone and occlusion then

maybe there is a simple way to determine the basal bone shape based on the

occlusal arch shape. Since basal bone is nebulous according to some,12 can one

even show that arch shape is the same at the two levels? If it is not, as long as

practitioners do not violate the bone and move teeth out of its parameters, stabil-

ity might not relate to a definition of basal bone. This study will look at the arch

form at the occlusal level and the basal bone level in black, white and Mexican

American patients to see if there is a difference in arch form between the two

levels or between the three groups.

4
 CHAPTER 2: REVIEW OF THE LITERATURE

Basal Bone

Lundstrom was the first to describe apical base as the portion of the bone

where the teeth rest30 and apical base has become interchangeable with basal

bone over the years. In 2000 the Glossary of Orthodontic Terms defined apical

base as the bone of the jaw that supports the teeth.31 Brash described the devel-

opment of the arch form as following the underlying bone shape initially and then

being shaped by the eruption of the teeth and forces of the surrounding muscula-

ture.8 Proffit discusses alveolar bone being formed and shaped by the teeth with-

in it so orthodontically moved teeth bring bone with them but there are limits as

fenestrations are seen if teeth are expanded beyond the limits of the bone.10 Ba-

sal bone is often interchanged with alveolar bone so this may be a reason that

basal bone is ill-defined. For Downs, apical base was defined in relation to point

A and point B on a cephalometric tracing.32 Salzmann combined Downs defini-

tion with Lundstroms to extend the apical base from the most constricted points

of the maxilla and mandible around the body of each parallel to the alveolar pro-

cesses.33 Howes said the basal arch was the apical portion of the alveolar bone

based on his work sectioning dental casts.34 It has been defined based on gingi-

val reference points,34-37 and tooth crown reference points.38 Bell demonstrated

that basal bone at the level of B point was very similar to basal bone at a level

below the root tips so it is not necessary to consider bone lower than B point in

order to have a continuous CBCT slice back to the 2nd molars.39 That study also

5
denied strongly held believes that basal bone, alveolar bone and teeth have a

strong relationship; the opposite was determined since there was a significant

correlation but it was too weak to be of any value.39 A different study showed a

significant correlation between the dental width and basal bone arch width based

on the WALA ridge.40 The WALA ridge was first described by Drs. Will and Larry

Andrews (the acronym derives from Will Andrews and Larry Andrews) as a band

of soft tissue coronal to the mucogingival junction of the mandible being near or

at the center of rotation of the teeth of which reflects the basal bone

underneath.41 Other works agreed that defining basal bone according to the WA-

LA ridge was a relatively simple clinical method of defining basal bone and that

the arch shape between this level and the crowns were not different.23, 42, 43 This

could indicate that keeping teeth in bone is the most important factor and that the

arch shape at the crown level is of sufficiency to base treatment archwires. It has

been suggested that basal bone does not change shape from mesial of mandibu-

lar 1st permanent molar to mesial of 1st permanent molar after age 5 years old34

and edgewise appliances do not alter the mandibular arch form 44 nor do they af-

fect the basal bone.45 Howes argued that if you compare the basal bone arch

form of a patient at 5 years of age versus 15 years of age there is no difference

in form or shape even though the form at the coronal level has changed to allow

for the eruption of permanent teeth.34 Fujita et al. concluded that the practical

significance of their finding that the dental arch width was associated with the

size of the adjacent skeletal unit but not the shape is that practitioners may use

the posterior basal arch width as a guide for choosing the archwire regardless of

6
the shape.46 Kim et al. suggested through their findings that the basal arch might

not be the principal factor in determining dental arch form and that the arch

shape variation is dental only.47 Brodie thought the description of apical base was

ambiguous due to the limits of contemporary methods to find and measure it. 4

Most of the studies mentioned here explored basal arch shape only looking at

cephs or models that can have error due to the accuracy of 2D representation in

the cephs or the method used in defining basal arch perimeter on the model.48

The advent of CBCT could help eliminate the ambiguity and standardize the re-

porting in the literature about the definition of basal bone to further support the

idea that the arch form at the crown level is no different from the bone level.

Orthodontic Stability and Relapse

Every orthodontist strives to achieve a good treatment result but is constantly

fighting the tendency of the teeth to return to the pre-treatment position. The re-

search available today looks for valid treatment methods to prevent relapse and

to define a reason for relapse such as arch form, wire selection, incisor irregulari-

ty or even race. Although the two are related, instead of focusing on relapse po-

tential it may be better to determine what makes treatment most stable.

Basal bone

For Tweed, stability occurred when the mandibular incisors were upright over ba-

sal bone and arch form was maintained.3 Brodie also believed that basal bone

7
was the key to stability and moving roots outside of it would result in relapse.4

Nance shared the same view as Tweed that altering arch form was unstable.5

Orthodontic forces

Some authors study the forces applied during orthodontic treatment. One article

found no effect on relapse from force magnitude but continuous forces resulted in

a longer period of relapse and more pronounced relapse than discontinuous

forces.2

Mandibular incisors

A significant portion of the literature focuses on lower incisor relapse because

this area seems to be at high-risk for relapse. An exhaustive review of the litera-

ture on mandibular incisor irregularity is beyond the scope of this work but a few

often-cited studies need to be mentioned in order to understand how orthodon-

tists view incisor irregularity. In 1972 Peck and Peck built on the idea that tooth

shape is a factor in mandibular incisor crowding and developed an index based

on mesio-distal versus facio-lingual dimensions. Their article argued that fixed

lingual retainers would only postpone the relapse if the index was too large and

suggested the need for interproximal reduction in order to make the tooth shape

more favorable.6 Littles 1975 article described a new index to categorize incisor

irregularity based on the linear displacement of the anatomic contact points of the

mandibular incisors mesial of the right canine to mesial of the left canine. He

suggested that the crowding of the mandibular incisors was the 1st evidence of a

8
progressive instability leading to maxillary crowding, bite deepening and loss of

arch length.49 Yu et al. suggested it is widely accepted that the anterior-posterior

thickness of the alveolar bone in the symphysis determines the distance that or-

thodontics can move the incisors.50 A study by Chaison et al. attempted to show

a way to predict relapse based on the alveolar volume, tooth volume and total

volume. While the study showed the lower incisor irregularity at appliance re-

moval and pre-treatment was a significant predictor for relapse the alveolar bone

volume was not shown to be a predictor.51 Another study showed that there was

no correlation between post-retention changes to incisor irregularity and arch

form but 69% of Class I patients and 64% of Class II patients had a tendency for

their arch form to relapse to the pre-treatment shape after appliance removal.22

The notion that lower incisor irregularity post-retention is relapse may be burden-

ing the orthodontist with more blame than is warranted. The literature reports that

intercanine width decreases and lower incisors crowd the farther out from treat-

ment52-55 but this decrease is also a natural part of the dentition aging56-59, similar

to wrinkles on the face. Maybe orthodontists should not be willing to take the

blame for this shift in teeth after treatment.

Intercanine width

As mentioned before, the literature reports that intercanine width decreases post-

treatment52-55 and as a natural aging process.56-58 Strang brought focus to the

mandibular canine to canine width as key to stability suggesting that increasing

this distance was only stable if it was because of moving the canine into a pre-

9
molar extraction site.7 Is it just a matter of altering the shape by moving the

crowns or if the change happens at the basal bone level will it be more stable i.e.

upright roots? In an article by McNamara et al. it was shown that most orthodon-

tists who responded to the questionnaire agreed that conserving the pre-

treatment canine to canine width was important in later stages of treatment but

there was no clear consensus how to do this. Pre-treatment study models, sym-

metry charts, age-related norms, incisal edges, imagined bracket positions or

buccal surfaces to adapt the archwires were all suggested as ways to preserve

the arch form for stability.21 If stability is related to intercanine width Mutinelli et

al. showed it is possible to keep the intercanine width but change the arch form.

For that study, no matter what the mathematical equation used to describe the

arch form, arch form can be changed by changing the length of the arch through

incisor proclination without changing the intercanine width.60

Race and ethnicity

There is little research into Hispanic oral health issues but, since it is the fastest

growing and largest minority in the United States, orthodontists need more re-

search into the differences, if any, of this population.61 One study by Vela et al.

concluded that European norms should not be used for Mexican-Americans be-

cause anterior-posterior position of incisors and proclination are different.62 Rely-

ing on norms for stability could be flawed due to the biased sample group of

which some of our traditional norms are based. Smith et al. compared whites,

blacks and Hispanics and demonstrated that the Bolton ratios, a ratio of the

10
combined tooth mass of the mesio-distal size of mandibular teeth to maxillary

teeth, should not be used in males of any race, Hispanic or black females be-

cause the only group that adhered to the norms was the white female group. 27

Genetics versus Environment

Genetics may account for an average of 50% of arch size and 39% of arch shape

(length to width ratios) but both are considered to be subject to environment

more than genetics.9 This could be why a majority of arch forms tend to return to

pre-treatment shape after retention.22 It is not because teeth are programmed to

be in a specific place but may be the environment--such as tongue, cheeks, lips,

bonethat dictates stability. De La Cruz et al. pointed out in their findings that

there was no correlation between post-retention changes in incisor irregularity or

changes to arch width/length and arch form and that maybe the small magnitude

of post-retention changes was associated with the sample being premolar extrac-

tion space closure.22 This suggests that even though we may change the arch

form considerably, especially in extraction cases, it can still be stable if the teeth

are in equilibrium with the oral cavity. This idea was supported in another article

that concluded that there was an association between dental arch width and ad-

jacent skeletal unit for size but not shape.46

Aging

We know that growth continues throughout our entire lifetime 63 but it has been

suggested that the arch form does not change from kids to adults 35 therefore the

11
arch form seen in a typical age group for orthodontic treatment should be stable

into adulthood.

Other factors

In their article De La Cruz et al. stated that those patients that had the most

change during treatment were not necessarily the patients that had the most re-

lapse post-retention. They concluded it was erroneous to infer that if the original

arch form was maintained there would be no relapse.22 In 2011 Lee et al. con-

cluded that the arch form was influenced by tooth size, arch width, basal bone

width and inclination of the posterior teeth so if the arch shape was changed at

the occlusal level by tipping the teeth but the basal bone shape was different and

unchanged, this could lead to instability and relapse.64 Some authors argue that

this could relate to the use of pre-formed wires and suggest that commercial

wires are significantly different in shape than the ideal arch form.65 Some have

even shown that there is a correlation between tooth size and relapse.66-68 Ka-

naan failed to show a correlation between basal bone discrepancy and relapse or

between tooth size and relapse.69 Case was at odds with Angle because he be-

lieved that extractions were necessary for stability in some patients to harmonize

the teeth with the bone.29

Mandibular Arch Form

It is frequently proposed that arch shape falls into three broad categories:

ovoid, square or tapered.70-72 The classic descriptions used for arch shape have

12
included ellipse,22, 73-76 a parabolic curve,73, 75 straight segments joined to half a

circle,77-79 a catenary curve80, 81 or a hyperbola.75

Commercial wires

For a company to sell wires there has to be a starting point of some kind but cau-

tion should be used in applying one shape to all patients. Camporesi et al. com-

pared their ideal arch form and 10 wires. They found a significant shape differ-

ence for all the wires compared to the ideal with one particular manufacturers

ovoid shape showing the greatest shape difference in the mandibular arch.65

Weaver et al. showed significant changes to the dental arch with preformed wires

compared to the controls but no change with the use of custom wires formed to

the WALA ridge.40 Several templates follow the form of incisal edges and buccal

cusp tips to form a wire since it has been suggested this is elliptical75 but more

recently the facial axis has gained support since that is where the archwire will be

fixed to the crown.41-43, 47

Race and ethnicity

Racial differences in anatomy and physiology have been studied but the litera-

ture is lacking in material to suggest whether or not race is a factor for orthodon-

tists in choosing arch form. As mentioned previously, there is little research into

the health needs of Hispanics61 but studies between the developmental differ-

ences of whites and Mexicans are available. For skeletal differences Garcia

showed that bimaxillary prognathism was seen more in Mexicans than whites25

13
and Phelan determined that Class II Mexicans had greater protrusion and greater

vertical height measurements than whites.82 For dental differences Buschang

and Shulman showed Mexicans have more lower incisor irregularity than whites24

and Bishara et al. showed Mexicans have larger tooth sizes than whites.26 Blacks

have been shown to have wide palates and large jaws.83 The Mongoloid race

that was a precursor to Mexican-Indians, tended to have arches that were para-

bolic in form.83 It has been shown repeatedly that whites have predominantly ta-

pered or ovoid arches.71, 84, 85 One study of Brazilian adolescents showed 23 dif-

ferent arch forms present in the mandible alone.86 Previous studies have shown

that blacks on average have arches with wider mandibular posterior segments

than whites or Hispanics and Hispanics have larger anterior ratios than blacks.27,
28
Other studies showed that blacks had larger teeth, larger arches and more

square form than whites.28, 87, 88 Gimlen showed that overall Hispanics had a 70%

distribution of square form followed by tapered and ovoid being equal while

whites had 80% tapered equaling ovoid and the remaining 20% being square. 84

Comparing just Class I patients tapered and ovoid was over 90% in whites while

Hispanics was square, Class II was tapered for whites while Hispanics was

square and Class III was the only subset where square predominated in both

groups.84 Lins findings state there was no significant difference found between

the arch parameters of whites, Hispanics and blacks89 but this may be due to

small sample size since the whites were N=16, Hispanics N=8 and blacks N=0.

Ferrario et al. studied Chilean mestizos against Italian whites and found that

overall the white arches were smaller than the mestizo arches.90

14
 Frequency of form

The mandibular arch form is often the focus of studies rather than the maxilla due

to it being the one least able to be modified with orthodontics.23, 91 Of several

arch forms Felton et al. showed that no one arch form is seen more often than

another in untreated normal, pre-treatment Class I or pre-treatment Class II den-

tition but the closest commercial arch form was the Par and Vari-Simplex shapes

at about 50% of all three groups combined.70 That study also concluded that

60% of the treated cases in Class I and Class II patients had a different arch form

post-treatment and 70% had relapse long-term.70 Tajik et al., on the other hand,

concluded that 49.2% of pre-treatment Class I, II and III subjects had a tapered

arch form.11 Nojima et al. showed 42% ovoid in the Japanese sample and 38%

ovoid in the Caucasian sample that is similar but there was a great difference in

the division of the remaining patients as 46% square in the Japanese and only

18% square in the Caucasian.71 Paranhos et al. showed only 20% of the subjects

in the study had tapered form and oval was the most prevalent at 41% but the

authors did point out that this was a subjective choice of people looking at the

arches and comparing to one of the three standard forms.92 Dr. McLaughlin rec-

ommends in his textbook that for a Caucasian practice the ratio of wire shapes

should be 45% ovoid, 45% tapered and 10% square.72

Intercanine width

Ball et al. concluded that their sample of Class II subjects did have a different in-

tercanine width between dental and basal arches but that it was unlikely to affect

15
the arch form as it was only 0.8 mm.23 Although it seems logical that moving any

one tooth should be as stable as moving any other tooth orthodontists tend to

value the width of the canines above other arch measurements. 21 This may relate

to the idea that the surrounding musculature and oral environment dictate arch

form most and that the canines are positioned at the corners of the mouth where

pressure can be great due to the circumoral muscles.8-11 This is at odds with

what White concluded that the arrangement of the teeth into an arc was predom-

inantly dictated by the osseous bases of the jaws.93 In a 1999 study Braun et al.

determined that the natural mandibular form of molar to canine ratio was 2.38:1

where the nickel-titanium (NiTi) wires of three different manufacturers had a ratio

of 1.87:1 and that the wires changed the mandibular intercanine width an aver-

age of 5.95 mm and intermolar width 0.84 mm.94 Another study by Bhowmik et al.

showed that the mathematical beta function with the least squares method ex-

pressed the normal occlusal shape with a correlation coefficient of 0.97 in their

control group and they showed a natural mandibular molar to canine ratio of

2.11:1 while the wires were 1.78:1.95 This study used 0.019x0.025 rectangular

NiTi wires of several different manufactures, a size of wire considered past the

initial leveling and aligning stage of treatment, and had an intercanine width on

average 6.667 mm larger in females and 5.337 mm larger in males than the con-

trol group.95 These studies imply the greater change in the area that most ortho-

dontists say should be conserved. Arai and Will argued that measuring a canine-

canine width of 22.96-29.0 mm might be all that is needed clinically to classify the

arch as ovoid.96

16
 Mathematical representation of arch form

The mathematical Beta function has been shown to be a planar representation of

the natural human arch form.97 However, an alternative function has been sug-

gested to describe tapered, ovoid and square dental arch forms.98 Arai and Will

found a significant positive correlation between subjective rankings of arch form,

canine/molar ratio and 4th order polynomial equation and a significant negative

correlation between subjective rankings of arch form, canine/molar ratio and 2nd

order polynomial equation demonstrating arches with wider intercanine distance

than intermolar distance tend to be ranked square by subjective means. 96 Lee et

al. argued that although higher order polynomials may be more precise in fit, be-

cause of the inherent asymmetries in all arches the form may become inaccurate

along the curve so they suggest 3rd order polynomial is sufficient to get the gen-

eral idea of the curve.64 Alvaran et al. discussed that the bigonial width was the

most important determinant of posterior arch width while the size of the incisors

was the most important for anterior arch width.99 This agrees with Gimlens re-

sults of a more square arch form in Hispanics84 since their lower anterior teeth

are larger.24, 26, 27

Cone Beam Computed Tomography

Cone Beam Computed Tomography (CBCT) is gaining interest as a diagnos-

tic resource in orthodontics. It evolved from the original computerized tomogra-

phy (CT) developed by Hounsfield in 1967. The main difference being that the

CBCT allows for a single rotation versus a CT using multiple passes and stacking

17
the slices into one image.100 There is much research on the validity of using

CBCT as well as the accuracy of the measurements derived from it. Tarazona et

al. compared tooth sizes, intercanine width, intermolar width and arch lengths us-

ing CBCT against digitized study models and found significant differences for

some individual tooth measurements, mandibular intercanine width and mandibu-

lar arch length but the differences were less than 1% therefore clinically irrele-

vant.101 Timock et al. determined at a correlation coefficient of 0.98 that buccal

bone height can be accurately measured to a mean difference of 0.30 mm.102

Leung et al. said that alveolar bone height can be accurately measured to

0.6 mm when using a voxel size of 0.38 mm at 2 mA and that root fenestrations

could be identified with greater accuracy than dehiscence.103 Damstra et al. de-

termined that an increase in voxel resolution from 0.40 mm to 0.25 mm did not

result in a greater accuracy of linear measurements104 while Sun et al. suggest

that alveolar bone height measurements using a 0.4 mm voxel size might overes-

timate the loss associated with RPE.105 Periago et al. used human skulls to com-

pare CBCT to direct measurements and although there were statistical differ-

ences between the two they were considered clinically equal.106 Hassan et al.

findings agreed with the 3D versus physical measurements and added a compar-

ison with 2D images and determined that the 3D images were closer to the phys-

ical measurements than 2D images or 2D slices even when the patient position

was rotated.107 Wang et al. imaged teeth with CBCT scanning before extraction

to compare to Micro-CT scanning after extraction and found that the volumetric

measurement of teeth using a CBCT in vivo is comparable to Micro-CT in vitro

18
indicating that CBCT can be a valuable way to examine root resorption during

orthodontic treatment.108 Another study compared CBCT to digital caliper meas-

urements and found the CBCT to be highly reliable at a correlation greater than

0.90 but the CBCT tended to underestimate slightly the anatomic truth. 109 Zamo-

ra et al. compared lateral cephalograms to CBCT and determined no statistically

significant differences for angular or linear measurements.110 Alqerban et al.

showed that CBCT was more sensitive than panoramic x-rays for canine localiza-

tion and the identification of root resorption on adjacent teeth. 111 Bell compared

CBCT slices to plaster model measurements and found hard tissue measure-

ments were obtained with relative ease.39 He could standardize the orientation

and filter out the soft tissue to allow for an accurate and reproducible method to

make bony measurements.39 Schlicher et al. found that since point B lies along a

curve without clear anatomic boundaries there was error in the y-axis plane but

that the error was no more in the 3D CBCT scans than in the 2D ceph identifica-

tion.112 There is a need for caution when working with CBCT images as Molen

argued that protocols are needed in the reporting of CBCT research to ensure

correct representation as spatial resolution is the minimum distance needed to

distinguish two objects and it does not equal voxel size because of noise, arti-

facts and partial volume averaging.113 Despite this caution it is suggested that

CBCT offers an undistorted view of the dentition that shows details of individual

dental morphology, features of roots and spatial orientation of teeth and roots

without any magnification error since CBCT images are recreated using a math-

ematical algorithm.114

19
 Statement of Thesis

This study will be a retrospective look at the natural arch form of black, white

and Mexican American patients before treatment and determine if there is any

difference in overall shape at basal bone level and occlusal level. Since pre-

formed wires tend to be the same shape and not designed to follow the natural

dental arch form94 a difference in arch shape between the two levels may con-

tribute to orthodontic instability. Using CBCT pre-treatment images will be exam-

ined looking at the mandibular basal arch shape compared to the occlusal arch

shape. Reorientation of the CBCT to orient the mandible along the functional oc-

clusal plane in order to make image slices that show basal bone in the anterior

as well as the posterior would be the first step. Basal bone will be defined ac-

cording to Kanaans method of a parallel line to functional occlusal plane (FOP)

drawn from B point and a perpendicular line from FOP at mesial contact of man-

dibular 1st molars.69 The dependent variable measured will be slices taken at ba-

sal bone level and slices taken at occlusal level, the mandible only, and placing a

point midway between the cortical plates to give us the arch shape at basal bone

while using the Noroozi method for arch shape at the occlusal level.98 This shape

will be compared to the three prominent arch shapes to classify as ovoid, tapered

or square. The millimetric difference in the arch will not be considered, only the

overall shape. The shape will be classified based on Noorozis definition of

square, ovoid and tapered.98 The alternative hypothesis is: there is a difference in

basal bone arch shape vs. functional occlusal arch shape. The null hypothesis is:

20
there is no difference between the functional occlusal and basal arch shapes.

The sample size will be 50 for each group (black, white and Mexican American)

and come from an existing set of patient records located at Saint Louis University

CADE that include pre-treatment CBCT images. The selection criteria will in-

clude: permanent lower dentition that includes the second molars, no previous

orthodontic intervention, age 18 or younger, no impacted teeth on the mandible,

and mild crowding without any tooth blocked out of the arch.

21
 Literature Cited

1. Hawley CA. A removable retainer. Int J Orthod. 1919;2:291-8.

2. Van Leeuwen EJ, Maltha JC, Kuijpers-Jagtman AM, Van't Hof MA. The effect
of retention on orthodontic relapse after the use of small continuous or
discontinuous forces. Eur J Oral Sci. 2003;111:111-6.

3. Tweed CH. Indications for the extraction of teeth in orthodontic procedure. Am

J Orthod Oral Surg. 1944;42:22-45.

4. Brodie AG. Appraisal of present concepts in orthodontia. Angle Orthod.

1950;20:24-38.

5. Nance HN. The limitations of orthodontic treatment; diagnosis and treatment in

the permanent dentition. Am J Orthod. 1947;33:253-301.

6. Peck H, Peck S. An index for assessing tooth shape deviations as applied to

the mandibular incisors. Am J Orthod. 1972;61:384-401.

7. Strang R. Factors associated with successful orthodontic treatment. Am J

Orthod. 1952;38:790-800.

8. Brash JC, McKeag HTA. The Aetiology of Irregularity and Malocclusion of the
Teeth. London, England: Dental Board of the United Kingdom; 1956.

9. Cassidy KM, Harris EF, Tolley EA, Keim RG. Genetic influence on dental arch
form in orthodontic patients. Angle Orthod. 1998;68:445-54.

10. Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. 4th ed. St.
Louis, MO: Mosby Elsevier; 2007.

11. Tajik I, Mushtaq N, Khan M. Arch forms among different angle classifications
a study. Pakistan Oral & Dental Journal. 2011;31:92-5.

12. Burstone CJ, Marcotte MR. Problem-Solving in Orthodontics: Goal-Oriented

Treatment Strategies. Chicago, IL: Quintessence Publishing Company;
2000.

13. Pang A. Relation of musical wind instruments to malocclusion. J Am Dent

Assoc. 1976;92:565-70.

14. Herman E. Influence of musical instruments on tooth positions. Am J Orthod.

1981;80:145-55.

15. Engelman JA. Measurement of perioral pressures during playing of musical

wind instruments. Am J Orthod. 1965;51:856-64.

22
16. Kusters ST, Kuijpers-Jagtman AM, Maltha JC. [The arrangement of trans-
septal fibers in rotated and non-rotated emerged teeth in beagle dogs].
Ned Tijdschr Tandheelkd. 1991;98:112-4.Dutch.

17. Ahrens DG, Shapira Y, Kuftinec MM. An approach to rotational relapse. Am J

Orthod. 1981;80:83-91.

18. Little BB, Buschang PH, Reyes MEP, Tan SK, Malina RM. Craniofacial
dimensions in children in rural Oaxaca, Southern Mexico: Secular change,
1968-2000. American Journal of Physical Anthropology. 2006;131:127-36.

19. Horner KA, Behrents RG, Kim KB, Buschang PH. Cortical bone and ridge
thickness of hyperdivergent and hypodivergent adults. Am J Orthod
Dentofacial Orthop. 2012;142:170-8.

20. Park H, Boley JC, Alexander RA, Buschang PH. Age-related long-term
posttreatment occlusal and arch changes. Angle Orthod. 2010;80:247-53.

21. McNamara C, Drage KJ, Sandy JR, Ireland AJ. An evaluation of clinicians'
choices when selecting archwires. Eur J Orthod. 2010;32:54-9.

22. De La Cruz A, Sampson P, Little RM, Artun J, Shapiro PA. Long-term

changes in arch form after orthodontic treatment and retention. Am J
Orthod Dentofacial Orthop. 1995;107:518-30.

23. Ball RL, Miner RM, Will LA, Arai K. Comparison of dental and apical base
arch forms in Class II Division 1 and Class I malocclusions. Am J Orthod
Dentofacial Orthop. 2010;138:41-50.

24. Buschang PH, Shulman JD. Incisor crowding in untreated persons 15-50
years of age: United States, 1988-1994. Angle Orthod. 2003;73:502-8.

25. Garcia CJ. Cephalometric evaluation of Mexican Americans using the Downs
and Steiner analyses. Am J Orthod. 1975;68:67-74.

26. Bishara SE, Jakobsen JR, Abdallah EM, Fernandez Garcia A. Comparisons
of mesiodistal and buccolingual crown dimensions of the permanent teeth
in three populations from Egypt, Mexico, and the United States. Am J
Orthod Dentofacial Orthop. 1989;96:416-22.

27. Smith S, Buschang P, Watanabe E. Interarch tooth size relationships of 3

populations: "does Bolton's analysis apply?". Am J Orthod Dentofacial
Orthop. 2000;117:169-74.

28. Merz ML, Isaacson RJ, Germane N, Rubenstein LK. Tooth diameters and
arch perimeters in a black and a white population. Am J Orthod
Dentofacial Orthop. 1991;100:53-8.

23
29. Case C. Techniques and Principles of Dental Orthopedia. Chicago, IL: CS
Case Company; 1921.

30. Lundstrom A. Malocclusion of the teeth regarded as a problem in correction

with the apical base. Int J Orthod Oral Surg Radiogr. 1923;11:591-602.

31. Daskalogiannakis J. Glossary of Orthodontic Terms. Leipzig, Germany:

Quintessence Books; 2000.

32. Downs WB. Variations in facial relationships: Their significance in treatment

and prognosis. Am J Orthod. 1948;34:812-40.

33. Salzmann JA. Orthodontic therapy as limited by ontogenetic growth and the
basal arches. Am J Orthod. 1948;34:297-319.

34. Howes AE. Expansion as a treatment procedure- where does it stand today?
Am J Orthod. 1960;46:515-34.

35. Gupta D, Miner RM, Arai K, Will LA. Comparison of the mandibular dental
and basal arch forms in adults and children with Class I and Class II
malocclusions. Am J Orthod Dentofacial Orthop. 2010;138:10 e1-8;
discussion -1.

36. Miethke RR, Lindenau S, Dietrich K. The effect of Frankel's function regulator
type III on the apical base. Eur J Orthod. 2003;25:311-8.

37. Rees DJ. A method for assessing the proportional relation of apical bases
and contact diameters of the teeth. Am J Orthod. 1953;39:695-707.

38. Falck F. Comparative studies on the development of the tooth root following
orthodontic treatment with the active plate and function regulator. Fortschr
Kieferorthop. 1969;30:225-9.

39. Bell GD, Behrents RG, Kim KB, Oliver DR. Three-dimensional cone beam
computerized tomography assessment of basal bone parameters and
crowding: Saint Louis University; 2008.

40. Weaver KE, Tremont TJ, Ngan P, Fields H, Dischinger T, Martin C, Richards
M, Gunel E. Changes in dental and basal archforms with preformed and
customized archwires during orthodontic treatment. Orthdontic Waves.
2012;71:45-50.

41. Andrews LF, Andrews WA. The six elements of orofacial harmony. Andrews
J. 2000;1:13-22.

42. Trivio T, Siqueira DF, Andrews WA. Evaluation of distances between the
mandibular teeth and the alveolar process in Brazilians with normal
occlusion. Am J Orthod Dentofacial Orthop. 2010;137:308.e1-e4.

24
43. Ronay V, Miner RM, Will LA, Arai K. Mandibular arch form: the relationship
between dental and basal anatomy. Am J Orthod Dentofacial Orthop.
2008;134:430-8.

44. Riedel RA. A review of the retention problem. Angle Orthod. 1960;30:179-99.

45. Vanarsdall RL, Jr., Secchi AG, Chung CH, Katz SH. Mandibular basal
structure response to lip bumper treatment in the transverse dimension.
Angle Orthod. 2004;74:473-9.

46. Fujita K, Takada K, QianRong G, Shibata T. Patterning of human dental arch

wire blanks using a vector quantization algorithm. Angle Orthod.
2002;72:285-94.

47. Kim KY, Bayome M, Kim K, Han SH, Kim Y, Baek SH, Kook YA. Three-
dimensional evaluation of the relationship between dental and basal arch
forms in normal occlusion. Korean J Orthod. 2011;41:288-96.

48. Athar A, Kim KB, Araujo E, Behrents RG. An assessment of mandibular

apical base and curve of spee from a developmental perspective: Saint
Louis University; 2011.

49. Little RM. The irregularity index: a quantitative score of mandibular anterior
alignment. Am J Orthod. 1975;68:554-63.

50. Yu Q, Pan XG, Ji GP, Shen G. The association between lower incisal
inclination and morphology of the supporting alveolar bone--a cone-beam
CT study. Int J Oral Sci. 2009;1:217-23.

51. Chaison JB, Chen CS, Herring SW, Bollen AM. Bone volume, tooth volume,
and incisor relapse: a 3-dimensional analysis of orthodontic stability. Am J
Orthod Dentofacial Orthop. 2010;138:778-86.

52. Bishara SE, Chadha JM, Potter RB. Stability of intercanine width, overbite,
and overjet correction. Am J Orthod. 1973;63:588-95.

53. Glenn G, Sinclair PM, Alexander RG. Nonextraction orthodontic therapy:

posttreatment dental and skeletal stability. Am J Orthod Dentofacial
Orthop. 1987;92:321-8.

54. Little RM, Wallen TR, Riedel RA. Stability and relapse of mandibular anterior
alignment-first premolar extraction cases treated by traditional edgewise
orthodontics. Am J Orthod. 1981;80:349-65.

55. Taner TU, Ciger S, El H, Germec D, Es A. Evaluation of dental arch width

and form changes after orthodontic treatment and retention with a new
computerized method. Am J Orthod Dentofacial Orthop. 2004;126:464-75;
discussion 75-6.

25
56. DeKock WH. Dental arch depth and width studied longitudinally from 12
years of age to adulthood. Am J Orthod. 1972;62:56-66.

57. Henrikson J, Persson M, Thilander B. Long-term stability of dental arch form

in normal occlusion from 13 to 31 years of age. Eur J Orthod. 2001;23:51-
61.

58. Sillman J. Dimensional changes of the dental arches: longitudinal study from
birth to 25 years. Am J Orthod. 1964;50:215-28.

59. Sinclair PM, Little RM. Maturation of untreated normal occlusions. Am J

Orthod. 1983;83:114-23.

60. Mutinelli S, Manfredi M, Cozzani M. A mathematic-geometric model to

calculate variation in mandibular arch form. Eur J Orthod. 2000;22:113-25.

61. Ramos-Gomez F, Cruz GD, Watson MR, Canto MT, Boneta AE. Latino oral
health: A research agenda toward eliminating oral health disparities. J Am
Dent Assoc. 2005;136:1231-40.

62. Vela E, Taylor RW, Campbell PM, Buschang PH. Differences in craniofacial
and dental characteristics of adolescent Mexican Americans and
European Americans. Am J Orthod Dentofacial Orthop. 2011;140:839-47.

63. Behrents RG. A treatise on the continuum of growth in the aging craniofacial
skeleton [Doctoral dissertation]. Ann Arbor, Michigan: University of
Michigan; 1984.

64. Lee SJ, Lee S, Lim J, Park HJ, Wheeler TT. Method to classify dental arch
forms. Am J Orthod Dentofacial Orthop. 2011;140:87-96.

65. Camporesi M, Franchi L, Baccetti T, Antonini A. Thin-plate spline analysis of

arch form in a Southern European population with an ideal natural
occlusion. Eur J Orthod. 2006;28:135-40.

66. Fastlicht J. Crowding of mandibular incisors. Am J Orthod. 1970;58:156-63.

67. Smith RJ, Davidson WM, Gipe DP. Incisor shape and incisor crowding: a re-
evaluation of the Peck and Peck ratio. Am J Orthod. 1982;82:231-5.

68. Rhee SH, Nahm DS. Triangular-shaped incisor crowns and crowding. Am J
Orthod Dentofacial Orthop. 2000;118:624-8.

69. Kanaan W. The correlation between tooth size-basal bone size discrepancy
and long term stability of the lower incisors in Class II division 1 patients:
Saint Louis University; 2006.

26
70. Felton JM, Sinclair PM, Jones DL, Alexander RG. A computerized analysis of
the shape and stability of mandibular arch form. Am J Orthod Dentofacial
Orthop. 1987;92:478-83.

71. Nojima K, McLaughlin RP, Isshiki Y, Sinclair PM. A comparative study of

Caucasian and Japanese mandibular clinical arch forms. Angle Orthod.
2001;71:195-200.

72. McLaughlin RP, Bennett JC, Trevisi HJ. Systemized Orthodontic Treatment
Mechanics. St. Louis, MO: Mosby Elsevier; 2001.

73. Biggerstaff RH. Three variations in dental arch form estimated by a quadratic
equation. J Dent Res. 1972;51:1509.

74. Brader AC. Dental arch form related with intraoral forces: PR=C. Am J
Orthod. 1972;61:541-61.

75. Currier JH. A computerized geometric analysis of human dental arch form.
Am J Orthod. 1969;56:164-79.

76. Izard G. New method for the determination of the normal arch by the function
of the face. Int J Orthod Oral Surg Radiogr. 1927;13:582-95.

77. Bonwill WGA. The scientific articulation on the human teeth as founded on
geometrical, mathematical and mechanical laws. Dent Items Interest.
1899;21:617-43.

78. Hawley CA. Determination of the normal arch and its application to
orthodontia. Dent Cosmos. 1905;47:541-52.

79. Sved A. Mathematics of the normal dental arch. Dent Cosmos.

1917;59:1116-24.

80. Engel GA. Preformed arch wires: reliability of fit. Am J Orthod. 1979;76:497-
504.

81. Scott JH. The shape of the dental arches. J Dent Res. 1957;36:996-1003.

82. Phelan T, Buschang PH, Behrents RG, Wintergerst AM, Ceen RF,
Hernandez A. Variation in Class II malocclusion: comparison of Mexican
mestizos and American whites. Am J Orthod Dentofacial Orthop.
2004;125:418-25.

83. Hanihara K. Racial characteristics in the dentition. J Dent Res.1967;46:923-6.

84. Gimlen AA. Comparative study of Caucasian and Hispanic mandibular

clinical arch forms: University of Southern California; 2007.

27
85. Kook YA, Nojima K, Moon HB, McLaughlin RP, Sinclair PM. Comparison of
arch forms between Korean and North American white populations. Am J
Orthod Dentofacial Orthop. 2004;126:680-6.

86. Trivio T, Siqueira DF, Scanavini MA. A new concept of mandibular dental
arch forms with normal occlusion. Am J Orthod Dentofacial Orthop.
2008;133:10 e5-22.

87. Burris BG, Harris EF. Maxillary arch size and shape in American blacks and
whites. Angle Orthod. 2000;70:297-302.

88. Nummikoski P, Prihoda T, Langlais RP, McDavid WD, Welander U, Tronje G.

Dental and mandibular arch widths in three ethnic groups in Texas: a
radiographic study. Oral Surg Oral Med Oral Pathol. 1988;65:609-17.

89. Lin YT. The relationship between dental and basal anatomy of mandible in
Class I and Class III malocclusion: Tufts University School of Dental
Medicine; 2010.

90. Ferrario VF, Sforza C, Colombo A, Carvajal R, Duncan V, Palomino H.

Dental arch size in healthy human permanent dentitions: ethnic
differences as assessed by discriminant analysis. Int J Adult Orthodon
Orthognath Surg. 1999;14:153-62.

91. Little RM. Stability and relapse of dental arch alignment. Br J Orthod.
1990;17:235-41.

92. Paranhos LR, Andrews WA, Joias RP, Berzin F, Junior ED, Trivino T. Dental
arch morphology in normal occlusions. Braz J Oral Sci. 2011;10:65-8.

93. White LW. Individualized ideal arches. J Clin Orthod. 1978;12:779-87.

94. Braun S, Hnat WP, Leschinsky R, Legan HL. An evaluation of the shape of
some popular nickel titanium alloy preformed arch wires. Am J Orthod
Dentofacial Orthop. 1999;116:1-12.

95. Bhowmik SG, Hazare PV, Bhowmik H. Correlation of the arch forms of male
and female subjects with those of preformed rectangular nickel-titanium
archwires. Am J Orthod Dentofacial Orthop. 2012;142:364-73.

96. Arai K, Will LA. Subjective classification and objective analysis of the
mandibular dental-arch form of orthodontic patients. Am J Orthod
Dentofacial Orthop. 2011;139:e315-21.

97. Braun S, Hnat WP, Fender DE, Legan HL. The form of the human dental
arch. Angle Orthod. 1998;68:29-36.

28
98. Noroozi H, Nik TH, Saeeda R. The dental arch form revisited. Angle Orthod.
2001;71:386-9.

99. Alvaran N, Roldan SI, Buschang PH. Maxillary and mandibular arch widths of
Colombians. Am J Orthod Dentofacial Orthop. 2009;135:649-56.

100. Sukovic P, Brooks S, Perez L, Clinthorne NH. A novel design of a cone-

beam CT scanner for dentomaxillofacial imaging: Introduction and
preliminary results. CARS. 2001:700-5.

101. Tarazona B, Llamas JM, Cibrian R, Gandia JL, Paredes V. A comparison

between dental measurements taken from CBCT models and those taken
from a digital method. Eur J Orthod. 2013;35:1-6.

102. Timock AM, Cook V, McDonald T, Leo MC, Crowe J, Benninger BL, Covell
DA, Jr. Accuracy and reliability of buccal bone height and thickness
measurements from cone-beam computed tomography imaging. Am J
Orthod Dentofacial Orthop. 2011;140:734-44.

103. Leung CC, Palomo L, Griffith R, Hans MG. Accuracy and reliability of cone-
beam computed tomography for measuring alveolar bone height and
detecting bony dehiscences and fenestrations. Am J Orthod Dentofacial
Orthop. 2010;137:S109-19.

104. Damstra J, Fourie Z, Huddleston Slater JJ, Ren Y. Accuracy of linear

measurements from cone-beam computed tomography-derived surface
models of different voxel sizes. Am J Orthod Dentofacial Orthop.
2010;137:16 e1-6; discussion -7.

105. Sun Z, Smith T, Kortam S, Kim DG, Tee BC, Fields H. Effect of bone
thickness on alveolar bone-height measurements from cone-beam
computed tomography images. Am J Orthod Dentofacial Orthop.
2011;139:e117-27.

106. Periago DR, Scarfe WC, Moshiri M, Scheetz JP, Silveira AM, Farman AG.
Linear accuracy and reliability of cone beam CT derived 3-dimensional
images constructed using an orthodontic volumetric rendering program.
Angle Orthod. 2008;78:387-95.

107. Hassan B, van der Stelt P, Sanderink G. Accuracy of three-dimensional

measurements obtained from cone beam computed tomography surface-
rendered images for cephalometric analysis: influence of patient scanning
position. Eur J Orthod. 2009;31:129-34.

108. Wang Y, He S, Yu L, Li J, Chen S. Accuracy of volumetric measurement of

teeth in vivo based on cone beam computer tomography. Orthod
Craniofac Res. 2011;14:206-12.

29
109. Baumgaertel S, Palomo JM, Palomo L, Hans MG. Reliability and accuracy
of cone-beam computed tomography dental measurements. Am J Orthod
Dentofacial Orthop. 2009;136:19-25; discussion -8.

110. Zamora N, Llamas JM, Cibrian R, Gandia JL, Paredes V. Cephalometric

measurements from 3D reconstructed images compared with conventional
2D images. Angle Orthod. 2011;81:856-64.

111. Alqerban A, Jacobs R, Fieuws S, Willems G. Comparison of two cone beam

computed tomographic systems versus panoramic imaging for localization
of impacted maxillary canines and detection of root resorption. Eur J
Orthod. 2011;33:93-102.

112. Schlicher W, Nielsen I, Huang JC, Maki K, Hatcher DC, Miller AJ.
Consistency and precision of landmark identification in three-dimensional
cone beam computed tomography scans. Eur J Orthod. 2012;34:263-75.

113. Molen AD. Considerations in the use of cone-beam computed tomography

for buccal bone measurements. Am J Orthod Dentofacial Orthop.
2010;137:S130-5.

114. Mah JK, Huang JC, Choo H. Practical applications of cone-beam computed
tomography in orthodontics. J Am Dent Assoc. 2010;141 Suppl 3:7S-13S.

30
 CHAPTER 3: JOURNAL ARTICLE

Abstract

Introduction: Relapse continues to be a concern for todays orthodontists. Prac-

titioners agree that stability is a goal of treatment but there are many views on

which method of treatment will produce the most stable result. A change in arch

shape, or form, from the pre-treatment shape has been suggested as a reason

for instability. The literature reports many factors that play into how the shape of

the arch is developed including muscles, periodontal fibers, function, genetics,

race, intercanine width, and keeping teeth within basal bone. Purpose: This

study looks at the arch shape at occlusal plane versus the arch shape at basal

bone to determine if there is any difference between the two levels. Materials

and Methods: Using the CBCT of 150 black, white and Mexican American pa-

tients slices were taken at occlusal plane and basal bone levels. A canine ratio

was calculated for each level. Shape was classified into ovoid, tapered and

square based on the mean and standard deviation of the canine ratio. Results:

No significant difference was found between the arch shapes at the two levels.

Ovoid was the shape seen in a majority of patients at both levels. Conclusions:

No significant difference was apparent between the arch shapes at occlusal

plane versus BB levels. No significant difference of arch shape distribution be-

tween males and females or among the black, white and Mexican Americans.

31
 Introduction

Practitioners agree that stability is a goal of orthodontic treatment but there are

many views on which method of treatment will produce the most stable result.

Tweed, Brodie and Nance all agreed that stability relates to basal bone.1-3 Peck

and Peck argued that if the shape of the anterior teeth was disproportional based

on a ratio of mesio-distal versus bucco-lingual width there would be relapse and

suggested the need for interproximal reduction in order to make the tooth shape

more favorable.4 Strang argued that intercanine width was key to stability.5 The

following paragraphs will discuss several factors mentioned to attempt to define

how an arch form develops and why relapse happens.

There are perioral factors such as pressure from muscles, lips, cheeks or

habits to describe how the arch form develops. Many authors have stated the or-

bicularis oris, mentalis, buccinator, and tongue dictate arch form and tooth posi-

tion.6-10 Burstone and Marcotte continue by stating the dual muscular compo-

nents of the orbicularis oris could place pressure on the lower incisors only, up-

per incisors only or both.10 The buccinator influences the posterior width and the

canines can behave like posterior teeth if the oral slit is mesial to the canine al-

lowing the cheek to apply more pressure than the lips to the canines.10 Engelman

studied several types of habit-induced pressures and concluded thumb-sucking

produced the highest pressures, swallowing and whistling produced the lowest,

and instrument playing lay in between with brass instruments and the flute having

some influence.11

32
 There are anatomical factors to describe the development of the arch such as

divergence of the mandible to cranial base, memory of periodontal fibers or ge-

netic/racial influence. It has been shown that the attachment of periodontal fibers

is not determined by tooth anatomy but by the tooth position and orientation in

the arch12 and that a fibrotomy following orthodontic treatment may decrease the

amount of rotational relapse.13 Little et al. studied children in a rural Mexico vil-

lage over a 32-year period and showed the cranial complex remodeled to a

shorter head length and a narrower face.14 The study attributed these changes to

a decrease in food coarseness leading to a decrease in masticatory muscle func-

tion.14 Horner et al. built upon this research to study how mandibular plane angle

relates to bone development. The study described how mandibular cortical bone

thickness differs between hyperdivergent (patients that have a large facial diver-

gence and weaker muscle activity) and hypodivergent (patients that have a small

facial divergence and stronger muscle activity) individuals and concluded cortical

bone tends to be thicker in hypodivergent patients leading to a difference in alve-

olar ridge thickness.15 It has been shown that arch length and mandibular inter-

canine width both decrease over time as part of the natural aging process.16

Orthodontic factors that relate to arch form include pre-treatment arch form,

intercanine width, incisor irregularity and keeping teeth within basal bone. Main-

taining the pre-treatment arch form has been suggested by some practitioners as

a key to stable orthodontic results.17 Keeping the patients arch form while

straightening the teeth might make the end result less likely to relapse.18 There is

a limit to the change in posterior width, and particularly intercanine width, that

33
can be achieved and remain stable.10 Ball et al. argued that there is a different

intercanine width between dental and basal arches but that it was unlikely to af-

fect the arch form as it was only 0.8 mm.19 Incisor irregularity occurs in almost

everyone with roughly 50% of untreated adults having little to none and the re-

maining 50% having moderate to severe.20 Buschang and Shulman concluded

that incisor crowding was multifactorial and included ethnicity, number of first and

second molars, sex and age combined.20 Several studies have shown there is an

anatomical difference between whites, blacks and Mexicans. Garcia showed bi-

maxillary prognathism was seen more in Mexicans than whites,21 Buschang and

Shulman showed Mexicans have more lower incisor irregularity than whites, 20

and Bishara et al. showed Mexicans have larger tooth sizes than whites.22 Stud-

ies have shown that blacks have arches with wider mandibular posterior seg-

ments than whites or Hispanics and Hispanics have larger anterior ratios than

blacks.23, 24 With anatomical differences such as these one may expect that the

underlying bone is different between the three groups as well which may lead to

differences in the arch form distribution among the three groups.

Several authors believe that stability relates to keeping the original arch form

while maintaining the teeth over the underlying bone.1, 2, 5, 25 Basal bone has

been difficult to define2 so there is no one method of treatment that will ensure

stability. One could argue that arch form does not matter or that basal bone is not

definable.

If the arch shape is the same at the level of basal bone and occlusion then

maybe there is a simple way to determine the basal bone shape based on the

34
occlusal arch shape. Since basal bone is nebulous according to some,10 can one

even show that arch shape is the same at the two levels? If it is not, as long as

practitioners do not violate the bone and move teeth out of its parameters, stabil-

ity might not relate to a definition of basal bone. This study will look at the arch

form at the occlusal level and the basal bone level in black, white and Mexican

American patients to see if there is a difference in arch form between the two

levels or between the three groups.

Materials and Methods

Sample

The sample demographics consisted of orthodontic patients treated at a

private practice, Dr. Derid Ure and Dr. Joe Mayes (Lubbock, Texas) and at Saint

Louis University Center for Advanced Dental Education (St. Louis, Missouri). Pa-

tients presented voluntarily for the purpose of obtaining orthodontic treatment

and the records were taken as part of the initial diagnostic protocol. Patient rec-

ords were collected based on the criteria that the lower dentition was permanent

and included the second molars with the exception of a retained primary second

molar in the absence of a permanent second premolar. Other criteria included no

previous orthodontic intervention, age 18 or younger, no impacted teeth on the

mandible and mild crowding that did not have any teeth blocked out of the arch.

An a priori power analysis indicated a sample size of fifty samples per group for a

total of 150 samples. It was as close as possible split evenly male and female.

35
 Cone Beam Computed Tomography (CBCT) Technique

All CBCT files were imported into Dolphin 11.5 3D Imaging software (Dol-

phin Imaging Systems LLC, Chatsworth, CA). Using Dolphin the CBCT was reor-

iented so Y axis was at midline from frontal view and through the incisive fora-

men and vertebra C1 from the coronal view. X axis was along the functional oc-

clusal plane (FOP) from the right sagittal view and along the buccal cusps of 1st

molars from the frontal view. Z axis was along sella point from the right sagittal

view cut to reveal sella turcica. For occlusal plane arch level the points were

placed at midcontact of central incisors, cusp tip of right and left canines and

cusp tip of distobuccal cusp of right and left 2nd molars starting on the left side of

the mandible and going around the arch (Figure 3.1).

36
 Figure 3.1 Example of plotted points for occlusal plane slice in Mexican male.

Lines were created within the CBCT slice for intercanine width, canine

depth, intermolar width and molar depth (Figure 3.2). The Cartesian coordinates

were exported into Microsoft Office Excel 2010 (Microsoft Corp., Seattle, WA).

37
 Figure 3.2 Example of Mexican male occlusal plane measurements.

For basal bone (BB) level B point was located on a right sagittal view (Fig-

ure 3.3) and moved the X axis until it bisected B point.

38
 Figure 3.3 Example of B point landmark in Mexican female.

Points were placed midway between the cortical plates of the mandible at

the midway of central incisors, right and left canines and right and left distal root

of 2nd molars starting on the left side of the mandible and going around the arch

(Figures 3.4).

39
 Figure 3.4 Example of plotted points for BB slice in white female.

Lines were created within the CBCT slice for intercanine width, canine

depth, intermolar width and molar depth (Figure 3.5). The Cartesian coordinates

were exported into Microsoft Office Excel 2010 (Microsoft Corp., Seattle, WA).

40
 Figure 3.5 Example of Mexican male BB measurements.

Error Study

Ten percent of the total sample was chosen to be re-evaluated by a ran-

dom number generator at www.random.org.26 Fifteen CBCT records were meas-

ured again and the canine ratio was re-calculated. As a general rule, intra-class

correlations greater than or equal to 0.80 are considered adequate.

41
 Statistical Analysis

This study tested the null hypothesis that there is no difference in arch

shape between functional occlusal plane level and basal bone level. Excel plot-

ted the X axis and Z axis coordinates of each level and used a best-fit curved line

to create a graphical representation of the arch form (Figure 3.6).

Figure 3.6 Example of black female graph.

42
 In accordance with Noroozis ratio to describe arch form27 formulas were

designed within Excel to calculate the ratio at the occlusal plane and basal bone

levels (Table 3.1).

Table 3.1 Calculation of the canine ratio of OP and BB level based on the digitized land-
marks from Dolphin Imaging.
Digitized Measurement Name Value
intercanine width OP 25.2 canine ratio OP
canine depth OP 5.4 3.8
intermolar width OP 48.2
molar depth OP 38.9

intercanine width BB 19.2 canine ratio BB

canine depth BB 3.6 3.1
intermolar width BB 60.1
molar depth BB 34.8

The organized data in Excel was analyzed in order to classify the arch

form into ovoid, square and tapered using Noroozis description.27 Statistical

analysis using SPSS statistical analysis software (PASW Statistics Version 18.0,

SPSS, Inc.) was performed and means and standard deviations were calculated

for the arch form at both levels (Table 3.2).

43
 Table 3.2 Calculation of the mean and standard deviation for the canine ratios at the oc-
clusal and BB level. One STD above and below was calculated in order to classify the shape as
ovoid, square or tapered.
Occlusal plane shape
1 Ovoid =mean +/- 1 STD
2 Square >mean +/- 1 STD
3 Tapered <mean +/- 1 STD
Min/max 1 STD Mean STD
3.12 5.25 4.19 1.06
BB shape
1 Ovoid =mean +/- 1 STD
2 Square >mean +/- 1 STD
3 Tapered <mean +/- 1 STD
Min/max 1 STD Mean STD
2.74 4.46 3.60 0.86

Since the overall shape was the focus of this study and not the millimeter

difference between the arch shapes, the nonparametric statistical Kruskal-Wallis

and Mann Whitney U analyses were used to interpret the data. Type I error was

set to alpha=0.05.

Results

Cronbachs alpha intra-class correlations were 0.89 for the occlusal plane

level and 0.87 for the basal bone level indicating adequate reliability of meas-

urements. The Mann Whitney U test showed no significant difference between

the arch shape at the two levels for each group independently, male versus fe-

male or the three groups as a whole. The Kruskal-Wallis test found no significant

difference in the distribution of shape across the three groups. This study failed

44
to reject the null hypothesis. The ovoid shape was the majority shape displayed

in all three groups and no difference between genders (Table 3.3). The shapes

were 73.3% ovoid, 12.7% square and 14.0% tapered at the OP level and 72.0%

ovoid, 14.7% square and 13.3% tapered at the BB level.

Table 3.3 Distribution of shape across N=300. Ovoid is the majority shape.
Shape distribution
Variable_grouping Total
OP BB
Shape Shape
Count 110 108 218
ovoid % within Variable_grouping 73.3% 72.0% 72.7%
% of Total 36.7% 36.0% 72.7%
Count 19 22 41
shape square % within Variable_grouping 12.7% 14.7% 13.7%
% of Total 6.3% 7.3% 13.7%
Count 21 20 41
tapered % within Variable_grouping 14.0% 13.3% 13.7%
% of Total 7.0% 6.7% 13.7%
Count 150 150 300
Total % within Variable_grouping 100.0% 100.0% 100.0%
% of Total 50.0% 50.0% 100.0%

Discussion

This study showed no significance between the arch shapes at the two

levels and might suggest when the millimetric measurement is removed the oc-

clusal plane and basal bone follow each other. This agrees with the findings that

the dental arch form is shaped by the supporting bone, the peri-oral muscles, and

45
functional forces of the teeth.6-8, 10, 28 As Burstone and Marcotte mentioned the

anterior mandible remodels with the position of the incisors10 it is logical that the

shape of the bone is similar to the occlusal shape since the bone will remodel to

support the function of the teeth. The results of this study support the findings

that defining basal bone according to the WALA ridge can be a simple clinical

method to use19, 29-31 since this study did not find a difference between the overall

shape at the occlusal level versus the basal bone level.

Ovoid was the predominant arch seen in this study for blacks, whites and

Mexicans. This supports Lins findings32 but disagrees with previous findings that

suggest Mexicans are descended from a parabolic arch form 33 or that Hispanics

have a 70% distribution of square form.34 It also disagrees with the findings that

blacks have more square form than whites.24, 35, 36 Tajik et al. determined tapered

as the predominant arch form at 49.2% but the classification of arch form was a

best fit against existing commercial templates.9 Felton et al. showed no pre-

dominance of arch form37 which suggests the classification of ovoid, tapered and

square is subjective. What one person sees as a square arch form may be an-

other persons definition of a large ovoid form. When considering how the arches

were classified the shape distribution is logical. Arches were considered ovoid

within one standard deviation of the mean and in a normally distributed popula-

tion one would expect about 68% to fall within one standard deviation. Describing

distribution of arch form may therefore be an academic exercise since what one

person describes as ovoid may be another persons description of tapered. This

further strengthens the idea that arch form is individually unique and requires

46
customized consideration during treatment. The difference between ovoid, ta-

pered and square is really a difference of millimeters. Since size was not a con-

sideration in this study it is not surprising that shape is similar across gender and

across the groups since function dictates a shape that is relatively similar.

Based on the previous research available one might expect there to be

ethnic differences for arch form but the results of this study contradict this idea.

Again, this relates to the fact that this study looked at shape and not the millimet-

ric measurements of the different components. If the canine width and depth re-

mains unchanged and you expand the molar width or decrease the molar depth

(as in a premolar extraction case) it will change a tapered arch form to a more

ovoid arch form. The reverse holds true too that if you expand the canine width or

increase the molar depth without changing the molar width or canine depth the

arch form will become more tapered. A follow-up to this study could examine how

much change in millimeters in the canine or molar region would change the arch

form from one classification to another and if relapse happens in the cases that

the millimetric changes were enough to change the arch form classification.

Using the single arch form for treatment of any arch shape, or in the dif-

ferent groups, should not alone increase the potential for relapse. Using the

ovoid template will be in line with almost 75% of patients according to the results

of this study. Care should be taken to consider the millimetric dimension as using

a wire that is too big could cause other areas of instability i.e. the muscles, perio-

dontal issues, etc.38-40 The ovoid shape was seen in this study as the shape most

often seen but varying definitions of ovoid9, 37, 40 can make this statement clinical-

47
ly irrelevant. In reality, there may never be a generalized arch shape or form that

can be used as a template for in vivo arches. The fact that it is not described

consistently in literature available today may indicate that we need to stop look-

ing and focus on other areas of study to enlighten the search for reducing the risk

of relapse post-orthodontic treatment.

Conclusions

1. No significant difference was apparent between the arch shapes at FOP ver-

sus BB levels.

2. No significant difference of arch shape distribution between females and

males or among the black, white and Mexican American groups.

3. Ovoid was the majority of the shape observed in all three groups and at both

levels.

48
 Literature Cited

1. Tweed CH. Indications for the extraction of teeth in orthodontic procedure. Am

J Orthod Oral Surg. 1944;42:22-45.

2. Brodie AG. Appraisal of present concepts in orthodontia. Angle Orthod.

1950;20:24-38.

3. Nance HN. The limitations of orthodontic treatment; diagnosis and treatment in

the permanent dentition. Am J Orthod. 1947;33:253-301.

4. Peck H, Peck S. An index for assessing tooth shape deviations as applied to

the mandibular incisors. Am J Orthod. 1972;61:384-401.

5. Strang R. Factors associated with successful orthodontic treatment. Am J

Orthod. 1952;38:790-800.

6. Brash JC, McKeag HTA. The Aetiology of Irregularity and Malocclusion of the
Teeth. London, England: Dental Board of the United Kingdom; 1956.

7. Cassidy KM, Harris EF, Tolley EA, Keim RG. Genetic influence on dental arch
form in orthodontic patients. Angle Orthod. 1998;68:445-54.

8. Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. 4th ed. St.
Louis, MO: Mosby Elsevier; 2007.

9. Tajik I, Mushtaq N, Khan M. Arch forms among different angle classifications a

study. Pakistan Oral & Dental Journal. 2011;31:92-5.

10. Burstone CJ, Marcotte MR. Problem-Solving in Orthodontics: Goal-Oriented

Treatment Strategies. Chicago, IL: Quintessence Publishing Company;
2000.

11. Engelman JA. Measurement of perioral pressures during playing of musical

wind instruments. Am J Orthod. 1965;51:856-64.

12. Kusters ST, Kuijpers-Jagtman AM, Maltha JC. [The arrangement of trans-
septal fibers in rotated and non-rotated emerged teeth in beagle dogs].
Ned Tijdschr Tandheelkd. 1991;98:112-4.Dutch.

13. Ahrens DG, Shapira Y, Kuftinec MM. An approach to rotational relapse. Am J

Orthod. 1981;80:83-91.

14. Little BB, Buschang PH, Reyes MEP, Tan SK, Malina RM. Craniofacial
dimensions in children in rural Oaxaca, Southern Mexico: Secular change,
1968-2000. American Journal of Physical Anthropology. 2006;131:127-36.

49
15. Horner KA, Behrents RG, Kim KB, Buschang PH. Cortical bone and ridge
thickness of hyperdivergent and hypodivergent adults. Am J Orthod
Dentofacial Orthop. 2012;142:170-8.

16. Park H, Boley JC, Alexander RA, Buschang PH. Age-related long-term
posttreatment occlusal and arch changes. Angle Orthod. 2010;80:247-53.

17. McNamara C, Drage KJ, Sandy JR, Ireland AJ. An evaluation of clinicians'
choices when selecting archwires. Eur J Orthod. 2010;32:54-9.

18. De La Cruz A, Sampson P, Little RM, Artun J, Shapiro PA. Long-term

changes in arch form after orthodontic treatment and retention. Am J
Orthod Dentofacial Orthop. 1995;107:518-30.

19. Ball RL, Miner RM, Will LA, Arai K. Comparison of dental and apical base
arch forms in Class II Division 1 and Class I malocclusions. Am J Orthod
Dentofacial Orthop. 2010;138:41-50.

20. Buschang PH, Shulman JD. Incisor crowding in untreated persons 15-50
years of age: United States, 1988-1994. Angle Orthod. 2003;73:502-8.

21. Garcia CJ. Cephalometric evaluation of Mexican Americans using the Downs
and Steiner analyses. Am J Orthod. 1975;68:67-74.

22. Bishara SE, Jakobsen JR, Abdallah EM, Fernandez Garcia A. Comparisons
of mesiodistal and buccolingual crown dimensions of the permanent teeth
in three populations from Egypt, Mexico, and the United States. Am J
Orthod Dentofacial Orthop. 1989;96:416-22.

23. Smith S, Buschang P, Watanabe E. Interarch tooth size relationships of 3

populations: "does Bolton's analysis apply?". Am J Orthod Dentofacial
Orthop. 2000;117:169-74.

24. Merz ML, Isaacson RJ, Germane N, Rubenstein LK. Tooth diameters and
arch perimeters in a black and a white population. Am J Orthod
Dentofacial Orthop. 1991;100:53-8.

25. Case C. Techniques and Principles of Dental Orthopedia. Chicago, IL: CS

Case Company; 1921.

26. Haahr M. www.random.org/lists/ Dublin, Ireland1998-2012 [cited 2013

October 14].

27. Noroozi H, Nik TH, Saeeda R. The dental arch form revisited. Angle Orthod.
2001;71:386-9.

28. Braun S, Hnat WP, Fender DE, Legan HL. The form of the human dental
arch. Angle Orthod. 1998;68:29-36.

50
29. Weaver KE, Tremont TJ, Ngan P, Fields H, Dischinger T, Martin C, Richards
M, Gunel E. Changes in dental and basal archforms with preformed and
customized archwires during orthodontic treatment. Orthdontic Waves.
2012;71:45-50.

30. Trivio T, Siqueira DF, Andrews WA. Evaluation of distances between the
mandibular teeth and the alveolar process in Brazilians with normal
occlusion. Am J Orthod Dentofacial Orthop. 2010;137:308.e1-e4.

31. Ronay V, Miner RM, Will LA, Arai K. Mandibular arch form: the relationship
between dental and basal anatomy. Am J Orthod Dentofacial Orthop.
2008;134:430-8.

32. Lin YT. The relationship between dental and basal anatomy of mandible in
Class I and Class III malocclusion: Tufts University School of Dental
Medicine; 2010.

33. Hanihara K. Racial characteristics in the dentition. J Dent Res.1967;46:923-6.

34. Gimlen AA. Comparative study of Caucasian and Hispanic mandibular

clinical arch forms: University of Southern California; 2007.

35. Burris BG, Harris EF. Maxillary arch size and shape in American blacks and
whites. Angle Orthod. 2000;70:297-302.

36. Nummikoski P, Prihoda T, Langlais RP, McDavid WD, Welander U, Tronje G.

Dental and mandibular arch widths in three ethnic groups in Texas: a
radiographic study. Oral Surg Oral Med Oral Pathol. 1988;65:609-17.

37. Felton JM, Sinclair PM, Jones DL, Alexander RG. A computerized analysis of
the shape and stability of mandibular arch form. Am J Orthod Dentofacial
Orthop. 1987;92:478-83.

38. Bhowmik SG, Hazare PV, Bhowmik H. Correlation of the arch forms of male
and female subjects with those of preformed rectangular nickel-titanium
archwires. Am J Orthod Dentofacial Orthop. 2012;142:364-73.

39. Braun S, Hnat WP, Leschinsky R, Legan HL. An evaluation of the shape of
some popular nickel titanium alloy preformed arch wires. Am J Orthod
Dentofacial Orthop. 1999;116:1-12.

40. Arai K, Will LA. Subjective classification and objective analysis of the
mandibular dental-arch form of orthodontic patients. Am J Orthod
Dentofacial Orthop. 2011;139:e315-21.

51
 VITA AUCTORIS

Angela Williams was born in Poplar Bluff, MO on April 11, 1978. She has an

older brother and a younger sister and she has lived in Missouri and South Caro-

lina. She graduated from Scott City High School in 1996 and attended College of

Charleston earning a Bachelor of Arts in International Business in 2000.

Angela worked in the accounting field until continuing her education at Uni-

versity of Missouri Kansas City Dental School in Kansas City, MO receiving a

Doctor of Dental Surgery degree in May 2011. She began her orthodontic train-

ing at Saint Louis University in June 2011.

Angela has been married to her husband, Donnie, since August 1996. She

will complete her Masters of Science in Dentistry degree in December 2013.

Upon graduation, Dr. Williams and her husband plan to remain in Kansas City,

MO where Dr. Williams will take over an existing private practice.

52