Dental crowding and its relationship to mesiodistal

crown diameters and arch dimensions

D. Radnzic, BDS, MDSc, D.D. Orth., RCPS (Glasg.)
Rochdale, England

An investigation was carried out to determine the correlation among cumulative mesiodistal crown
widths, arch dimensions, and the degree of primary dental arch crowding. Two different ethnic groups
were studied-namely, indigenous British and Pakistani immigrant groups-to determine whether
similar correlations existed as part of a larger study of ethnic comparisons. Correlation matrix
computation and multiple regression analysis were among the tests used. The results showed that in
both ethnic groups there were very significant correlations between certain arch dimensions and
the degree of crowding. There was no significant correlation between cumulative mesiodistal crown
widths and dental crowding when considered in isolation. In combination with the other parameters,
however, cumulative mesiodistal crown widths contributed significantly to the overall regression
equation. This suggested a complex interrelationship among cumulative mesiodistal crown widths,
the various arch dimensions, and primary dental crowding. (AM J ORTHOD DENTOFAC ORTHOP
1988;94:50-8.)

N ante’ described dental crowding as the

difference between the space needed in the dental arch
and the space available in that arch-that is, the space
discrepancy. Thus, crowding or spacing can be de-
scribed as an expression of an altered tooth/ tissue ratio
or as a dentoalveolar disproportion.
The causes of crowding or spacing are, however,
still not fully understood. Hooton’ suggested that
crowding was probably the result of an evolutionary
trend toward a reduced facial skeletal size without a
corresponding decrease in tooth size.
Brash3 said that crowding was hereditary, the result
of interbreeding in ethnic groups who were physically
dissimilar. Other investigators such as Barb& and
Moore, Lavelle, and Spences suggested that environ-
mental factors (eg, soft diet and loss of arch length
caused by caries) were more important than genetic
factors, especially when ethnic groups were compared.
Many investigations have focused on the part played
by tooth size and various arch dimensions in relation
to dental crowding. Lundstriim,6 in a survey using max-
illary study models taken from 139 Swedish boys, with
a mean age of 13 years and with varying degrees of
crowding, found that as tooth size increased and arch
perimeter decreased, the degree of crowding increased.
This study was carried out in partial fulfillment of the requirements for the
MDSc degree while the author was working in the Orthodontic Department of
the University of Leeds Dental Hospital.
*Senior Dental Officer, Dental Department, Baillie Street Health Centre.
Mills,7 in a survey of 230 male subjects, found a
significant association between crowding and arch
width, but no significant differences in tooth size or
arch length between crowded and uncrowded arches.
Lundstr(im,8 in a study of Swedish males, showed
that those with large teeth were more likely to have
dental crowding than those with small teeth.
Fastlichtg came to a similar conclusion and found a
significant correlation between dental crowding and the
mesiodistal dimensions of maxillary and mandibular
permanent incisors. However, his sample size of 28
was rather small.
Norderval, Wisth, and Bae’O showed a significant
relationship between dental crowding and tooth size in
a study of two groups of Scandinavian adults exhibiting
“ideal” and crowded mandibular arches, respectively.
However, only incisor widths were measured.
Doris, Bernard, and Kuftinec” showed that tooth
size was uniformly larger in subjects with crowded
arches in a study of 80 North American subjects.
McKeown,12 however, found a greater correlation
between dental arch size and crowding than between
tooth size and crowding. He measured study models
taken from 65 subjects and found the correlation be-
tween arch width and crowding to be particularly high.
This led him to conclude that a narrow arch generally
predisposed to crowding.
A recent investigation was carried out by Howe,
McNamara, and O’Connor,13 who studied the relation-
ship among tooth size, arch size, and crowding. Two
Volume 94
Number I
Fig. 1. Points of measurement of arch widths.
groups of study models were used, one group obtained
from 18 male and 32 female subjects who exhibited
gross crowding, the other from 24 male and 30 female
subjects who exhibited little or no crowding. They
found that the two groups could not be distinguished
in terms of tooth size, but that arch dimensions in the
crowded group were generally smaller than in the non-
crowded group. They concluded that dental crowding
was associated with smaller dental arches, rather than
large teeth.
Therefore, it would appear from the literature that
conflicting evidence exists regarding the part played by
tooth size in the cause of primary crowding. Further
investigations are required to clarify the situation be-
cause it could have some bearing on the nature of treat-
ment provided for alleviation of such crowding. The
present investigation attempts to do this and also to
determine whether similar findings apply in two ethnic
groups whose environmental and dietary backgrounds
are somewhat dissimilar.
MATERIALS AND METHOD
Sixty pairs of dental casts taken from indigenous
British boys in Leeds and 60 pairs of casts taken from
Pakistani immigrant boys living in Rochdale, England,
were measured. Ages ranged from 13 years to 15 years
11 months. The samples were chosen at random (using
random number tables) from a larger sample in each
group that had met the selection criteria. The investi-
gation was limited to male children of the aforemen-
tioned age range for no other reason than availability.
The selection criteria were as follows:
1. All permanent teeth present in each arch (ex-
cluding second and third molars) and in a suf-
ficient state of eruption to permit measurement
of the mesiodistal crown dimension
Dental crowding 51
Fig. 2. Arch length measurement.
2. No previous orthodontic treatment involving the
deciduous, mixed, or permanent dentitions in
either arch
3. No large coronal restorations that might have
altered both coronal shape and size
4. Models undamaged in areas of measurement
For each pair of casts, the following parameters
were recorded in each arch:
1, Cumulative mesiodistal crown widths
2. Arch width
3. Arch length
4. Arch perimeter
5. Estimate of dentoalveolar disproportion
The measurements were repeated for each cast, with a
minimum period of 1 week between repeated measure-
ments. The method of making the measurements is
described below.
Cumulative mesiodistal crown widths
The cumulative mesiodistal crown width was cal-
culated as the sum of mesiodistal crown widths of in-
dividual teeth in each arch up to and including the first
permanent molars. Individual measurements were made
with a vernier gauge to the nearest 0.1 mm, with the
blades of the calipers held perpendicular to the long
axis of the tooth. I3
Arch width
Two dimensions of arch width were used:
1. Maximum distance between distal surfaces of
lateral incisors
2. Mean intermolar width as calculated from val-
ues obtained for buccal and lingual intermolar
widths
Both buccal and lingual intermolar dimensions were
measured from the point of intersection of the gingival
52 Radnzic Am. J. Orthod. Dentofac. Orthop.
July 1988

Table I. Comparison of mean values between crowded and noncrowded or spaced arches in the indigenous
British sample
Crowded arches Noncrowded arches
(-10 mm to +2.9 mm) (+3 mm to +25.9 mm)
Parameter t
(N = 60*) Mean (mm) Variance? Mean (mm) Variance? value

Maxilla
Cumulative crown widths 97.18 9.74 97.25 13.48 0.055 NS
Arch length 35.70 5.78 41.35 4.97 6.374$
Arch width 6-6 (mean) 41.91 18.67 46.88 18.08 2.998$
Arch width (lateral inci- 25.64 8.40 29.07 3.81 3.857$
sots)
Arch perimeter 96.90 15.87 109.50 22.47 7.210$
Mandible
Cumulative crown widths 90.20 6.76 89.48 11.64 0.550 NS
Arch length 31.69 1.97 36.86 2.81 7.809$
Arch width 6-6 (mean) 42.20 12.63 47.46 6.58 3.497t
Arch width (lateral inci- 20.55 7.12 24.10 4.11 4.5628
sors)
Arch perimeter 90.88 7.12 104.00 14.67 9.364$

*Denotes sample size.

I’ Denotes estimated population variance.
*Significant at P < 0.01.

margin with an extension gingival to the buccal and This method produced numerical values that were
lingual fissures of the first permanent molars. Mea- not significantly different (P < 0.01) from those ob-
surements were made with vernier calipers to the near- tained by direct measurements on the dental casts. How-
est 0.1 mm (Fig. 1). ever, it was found to be more reliable and far less time-
consuming than direct measurement. Variations in arch
Arch length shape did not appear to significantly influence the dif-
The measurement of arch length was accomplished ferences between calculated and directly measured val-
on each model with an engineering depth gauge, round- ues of arch perimeter (P < 0.01) in the samples studied
ing off to the nearest millimeter. in either of the ethnic groups.
For the present study, the arch length was defined
as the length of a perpendicular line from the contact Estimate of dentoalveolar disproportion
point between the permanent central incisors to a line No standard exists by which crowding or spacing
joining the distal surfaces of the first permanent molars can be expressed. Various indices have been sug-
(Fig. 2). gested. “-” However, it was believed that a numerical
estimate of space discrepancy would be more useful
Arch perimeter and easier to visualize.
This was calculated by means of a modification of The dentoalveolar disproportion or space discrep-
the formula suggested by Mills and Hamilton14: ancy was calculated as the numerical difference be-
tween the arch perimeter and the cumulative mesiodistal
Arch perimeter = 2 y2 + y crown widths (in millimeters) in each arch.lS In the
J present study, crowded arches were defined as those
where x = arch length, but substituting with a space discrepancy of +2.9 mm or less. Non-
crowded and spaced arches were defined as those
mean intermolar width with a space discrepancy of + 3 mm or more. The lim-
Y’ 2 its of the samples used in this study were - 10 mm
instead of to +2.9 mm for crowded arches, and + 3 mm to
buccal interrnolar width + 25.9 mm for noncrowded and spaced arches. A value
Y= of +2.9 mm space discrepancy was selected as the
2
baseline between crowded and noncrowded arches and
as suggested by Mills and Hamilton.14 not 0 mm as might be expected. This value was arbi-
Volume 94
Number 1
Dental crowding 53

Table II. Comparison of mean values between crowded and noncrowded or spaced arches in the Pakistani
immigrant sample
Crowded arches Noncrowded arches
(-10 mm to +2.9 mm) (+3 mm to +25.9 mm)
Pantmeter t
(N == 60*) Mean (mm) Variance? Mean (mm) Variancet value

Maxilla
Cumulative crown widths 97.51 39.37 99.02 26.56 0.621 NS
Arch length 35.60 18.04 42.93 9.92 4.864$
Arch width 6-6 (mean) 43.28 12.10 46.07 5.94 2.31 lf
Arch width (lateral inci- 27.95 9.63 30.67 1.05 3.077$
SOB
Arch perimeter 97.70 42.68 112.78 22.33 6.580$
Mandible
Cumulative crown widths 88.40 16.55 87.87 2.05 0.250 NS
Arch length 32.28 5.51 35.25 0.25 2.475 NS
Arch width 6-6 (mean) 42.38 7.47 44.71 5.29 1.580 NS
Arch width (lateral inci- 20.89 1.73 22.95 0.40 3.010$
sors)
Arch perimeter 90.00 19.65 99.25 7.58 3.962$

*Denotes sample size.

I’Denotes estimzed population variance.
$Significant at P < 0.01.

trary, but compensated for the slight discrepancy (in
borderline cas,es)between the calculated dentoalveolar
disproportion and that which was observed clinically.
Often, it was difficult in such cases to distinguish clin-
ically between very slightly crowded and noncrowded
arches. Similarly, arches with a calculated space dis-
crepancy of 0 mm often would appear clinically to be
very slightly crowded. A slight shift in the baseline
from 0 mm to + 2.9 mm was found to be adequate to
compensate for these slight differences.
To minimize random and systematic errors, all mea-
surements were performed by a single observer as sug-
gested by Hunter and Priest.” All models were then
remeasured, in a random order, with an intervening
period of at least 1 week to eliminate any possibility
of memory bias.
RESULTS
The results of Student’s t tests used to assess be-
tween mean values of the various parameters in both
crowded and uncrowded or spaced arches within each
ethnic group are shown in Tables I and II. The rela-
tionship among cumulative crown widths, arch sizes,
and dentoalveolar disproportion was examined by di-
viding each ethnic group into two ranges-those with
noncrowded a.nd spaced arches ( + 3 mm to + 25.9 mm
estimated space discrepancy) and those with crowded
arches (- 10 mm to +2.9 mm estimated space dis-
crepancy) . Comparisons of cumulative mesiodistal
crown widths and the various arch dimensions were
then made between these two ranges. No significant
difference (at P < 0.01) was found between the
crowded and noncrowded or spaced groups in cumu-
lative mesiodistal crown widths. This applied to both
the Asian and non-Asian ethnic groups. However, sig-
nificant differences were observed (at P < 0.01) in arch
lengths, arch widths, and arch perimeters between the
crowded and noncrowded or spaced arches in both
groups. Tables I and II show that crowded arches have
smaller arch lengths, arch widths, and arch perimeters
than noncrowded or spaced arches.
A correlation matrix for the various parameters was
computed. The correlation coefficients (r) for cumu-
lative mesiodistal crown widths and arch dimensions in
relation to the degree of dentoalveolar disproportion for
each ethnic group are shown in Tables III and IV.
No significant correlation was found between cu-
mulative mesiodistal crown widths and the amount of
dentoalveolar disproportion (at P < 0.01) in either of
the ethnic groups. However, significant correlations
were found between the various arch dimensions and
the amount of dentoalveolar disproportion (at P <
0.01) in both ethnic groups. The correlation between
arch width and dentoalveolar disproportion did not ap-
pear to be as significant in the Asian group as in the
indigenous group; the reason for this is not fully un-
derstood. Arch length and arch perimeter, however,
showed a highly significant correlation in both ethnic
groups, even at P < 0.001.
To further examine me relationship between the var-
54 Radnzic Am. J. Orthod. Dentofac. Onhop.
July 1988

Table III. Correlations among cumulative crown widths, arch dimensions, and dentoalveolar disproportion
in the indigenous British group
Correlation under test Intercept A (mm) Gradient B r* t value

Cumulative crown widths and dentoalveolar disproportion

Maxilla +11.32 -0.04 0.034 0.244 NS
Mandible +24.13 -0.20 0.177 1.370 NS
Arch length and dentoalveolar disproportion
Maxilla -26.11 +0.87 0.590 5.569$
Mandible -26.67 +0.96 0.555 5.087.t
Mean intermolar width and dentoalveolar disproportion
Maxilla - 23.68 +0.69 0.513 4.550t
Mandible -31.41 +0.85 0.550 5.015t
Interincisal width and dentoalveolar disproportion
Maxilla - 19.28 +0.98 0.514 4.56Ot
Mandible - 19.20 +0.96 0.493 4.319t
Arch perimeter and dentoalveolar disproportion
Maxilla -51.78 +0.57 0.742 8.432$
Mandible -49.80 +0.58 0.702 7.512$

*Denotes correlation coefficient.

tsignificant at P < 0.01.
$Significant at P < 0.001.

Table IV. Correlations among cumulative crown widths, arch dimensions, and dentoalveolar disproportion
in the Pakistani immigrant group
Correlation under test Intercept A (mm) Gradient B r* t value

Cumulative crown widths and dentoalveolar disproportion

Maxilla +7.91 -0.01 0.006 0.043 NS
Mandible + 3.96 +0.01 0.013 0.098 NS
Arch length and dentoalveolar disproportion
Maxilla - 25.59 +0.83 0.634 6.240$
Mandible - 11.70 +0.49 0.404 3.365t
Mean intermolar width and dentoalveolar disproportion
Maxilla - 20.86 +0.63 0.358 2.921 t
Mandible -3.85 +0.20 0.164 1.269 NS
Interincisal width and dentoalveolar disproportion
Maxilla -5.63 +0.46 0.246 1.930 NS
Mandible -6.31 +0.52 0.277 2.194 NS
Arch perimeter and dentoalveolar disproportion
Maxilla -44.94 +0.50 0.703 7.538$
Mandible -27.22 +0.34 0.588 5.541$

*Denotes correlation coefficient.

t Significant at P < 0.01.
$Significant at P < 0.001.

ious parameters and dentoalveolar disproportion, a step-
wise multiple regression analysis was applied to the
data. A five-step regression procedure was used with
automatic sequential deletion of the least significant
variables. Dentoalveolar disproportion was designated
the dependent variable; cumulative mesiodistal crown
widths, arch widths, arch length, and arch perimeter
were the independent variables or predictors. The re-
sults for each ethnic group are shown in Tables V
and VI. In both ethnic groups, the multiple correlation
coefficients were highly significant for maxillary and
mandibular arches. The partial regression coefficients
were significant (P < 0.01) for two predictors in the
first step of the regression-namely, cumulative me-
siodistal crown widths and arch perimeter. This is in
accord with the method of calculating dentoalveolar
Volume 94
Dental crowding !i!i
Number 1

Table V. Stepwise multiple regression analysis Table VI. Stepwise multiple regression analysis
applied to the indigenous British group data applied to the Pakistani immigrant group data
Partial
Lndepe;e;;iable m Independent variable regression
(predictor) coefjcient F ratio

Maxilla (Multiple correlation coey‘jicient = 1) (N = 60*) Maxilla (Multiple correlation coejj‘icient = I) (N = 60*)
Cumulative mesiodistal crown 0.986 617.8t Cumulative mesiodistal crown - 0.999 472.4t
widths widths
Interincisal width 0.005 0.001 NS Interincisal width 0.066 0.202 NS
Mean intermolar width 0.007 0.000 NS Mean intermolar width 0.048 0.129 NS
Arch length 0.001 0.000 NS Arch length 0.054 0.159 NS
Arch perimerer - l.ooo 22181t Arch perimeter 0.998 20435t
Mandible (Multiple correlation coeficient = I) (N = 60*) Mandible (Multiple correlntion coeficient = 1) (N = 60*)
Cumulative mesiodistal crown - 0.999 409.8t Cumulative mesiodistal crown 0.979 120.2t
widths widths
Interincisal width - 0.078 0.328 NS Interincisal width 0.001 0.001 NS
Mean intermolar width 0.291 5.012 NS Mean intermolar width 0.001 0.001 NS
Arch length -0.010 0.012 NS Arch length 0.001 0.000 NS
Arch perimcer 0.999 12941.f Arch perimeter - l.ooo 998831-

Dependent variable is dentoalveolar disproportion. Dependent variable is dentoalveolar disproportion.

*Denotes sample size used in the regression analysis *Denotes sample size used in the regression analysis.
t Significant at P < 0.01. t Significant at P < 0.01.

disproportion in the present study. Partial regression
coefficients for interincisal arch width, intermolar arch
width, and arch length were not statistically significant
(P < 0.01) in either ethnic group. The order of elim-
ination of predictors in the analysis was as follows: arch
length, interincisal arch width, mean intermolar arch
width, and cumulative mesiodistal crown width.
Random and systematic errors occurring between
repeated measurements were determined as part of a
larger investigation, but did not reach levels of statis-
tical significance (at P < 0.01).
DISCUSSIOIY
It would #appearfrom the analysis that the variables,
as considered collectively, contribute very significantly
to the variations in dentoalveolar disproportion. Of the
individual predictor variables, initially only cumulative
mesiodistal crown widths and, in particular, arch pe-
rimeter appeared to contribute significantly to the ef-
fectiveness of the overall regression. This was ob-
viously to be expected since dentoalveolar dispropor-
tion was calculated as the numerical difference between
cumulative rnesiodistal crown widths and arch perim-
eter. However, the partial regression coefficient for arch
perimeter (a predictor variable) was so highly signifi-
cant that the relative effectiveness of the predictor vari-
ables of interincisal arch width, intermolar arch width,
and arch len,gth was rendered insignificant. This view
was supported when a further regression analysis was
carried out with forced elimination of the predictor vari-
able arch perimeter. The partial regression coefficients
for predictors arch length and mean intermolar arch
width now became more significant (P < 0.01) than
the partial regression coefficient for cumulative me-
siodistal crown widths. This was supported also by the
correlation coefficients (Tables III and IV) obtained
from the computed correlation matrix.
The most important findings of the present inves-
tigation were as follows:
1. Significant correlations were present between
various arch dimensions and dentoalveolar dis-
proportion in both ethnic groups. Arch length
and arch perimeter in particular showed a sig-
nificant correlation even at P < 0.001.
2. The correlation coefficients for cumulative me-
siodistal crown widths were of a low order, sug-
gesting no significant correlation between cu-
mulative mesiodistal crown widths and dentoal-
veolar disproportion in either ethnic group when
considered in isolation. However, in combina-
tion with the other parameters, cumulative me-
siodistal crown widths appeared to make a sig-
nificant contribution to dentoalveolar dispropor-
tion in the overall regression equation. This
suggests a complex interrelationship between the
various parameters and dentoalveolar dispro-
portion.
The significant correlations found among arch
length, arch perimeter (and, to a lesser extent, arch
width), and crowding or spacing support the findings
56 Radnzic
of Mills,’ McKeown,” and Howe, McNamara, and
O’Connor.‘3 They do not support the findings of Fast-
licht,’ Norderval, Wisth, and B6e,” or Doris, Bernard,
and Kuftinec.” This would seem to suggest that arch
size is more important than tooth size as a cause of
crowding. However, all the parameters appear to be
interrelated and no single factor can be divorced com-
pletely from the others.
The clinical implications of these findings may be
important when considering the treatment of malocclu-
sions involving crowded dental arches.
Similar findings have led some investigators to sug-
gest that crowded arches should be treated by increasing
the arch size by expansion, rather than by a reduction
in the number of teeth. Howe and associatesI suggested
that greater attention may be given to those techniques
of treatment that increase arch length, rather than reduce
tooth mass. This, however, is an oversimplification as
the present investigation demonstrates. Also, other fac-
tors may be involved that have not been considered in
these investigations.
The author of the present investigation cannot agree
with this approach because clinical experience has
shown that arch expansion, unless accompanied by fa-
vorable growth, often leads to an unstable situation of
imbalance between occlusal forces and the soft-tissue
environment, with subsequent relapse.
Howe and associates’3 also pointed out that crowded
arches were often asymmetric and irregular in arch
form, and not simply smaller versions of uncrowded or
spaced arches. Similarly, tooth size cannot be ruled out
as an important contributory factor, although it certainly
is not the main factor.
The crown widths used in the calculations were
mean values. Obviously, there are individuals in both
ethnic groups whose tooth sizes vary markedly from
these values; it cannot be denied that in many cases in
which teeth are of abnormally small size, dental arches
tend to exhibit spacing-for example, when lateral in-
cisors are peg-shaped or conical. Therefore, general-
izations cannot be made; each arch must be assessed
and treated individually. Personal clinical experience
has shown that certain techniques of arch expansion
may occasionally be beneficial in carefully selected
young growing patients, but similar techniques of ex-
pansion, when applied to relieve crowding in nongrow-
ing or adult patients, will often lead to instability and
relapse. Therefore, in the majority of cases, carefully
planned extractions will continue to be an important
part of treatment in the relief of primary dental
crowding.
Am. J. Orthod. Dentofac. Orthop.
July 1988
I am most grateful to Mr. J. F. Gravely, Senior Lecturer
in Orthodontics, University of Leeds Dental Hospital, for his
advice and guidance during the investigation, and also to Mr.
A. J. Doyle, District Dental Officer, RochdaleDistrict Health
Authority, for provision of materials and facilities.
REFERENCES
Nance HN. The limitations of orthodontic treatment. AM J
ORTHODORAL SURG1947;33:177-223.
Hooton EA. Up from the ape. New York: The Macmillan Com-
pany, 1947.
Brash JC. The aetiology of irregularity and malocclusion of the
teeth. 2nd ed. London: Dental Board of the United Kingdom,
1956.
4. Barber TK. The crowded arch. J S Calif Dent Hyg Assoc
1967;35:232-40.
5. Moore WJ, Lavelle CLB, Spence TF. Changes in the size and
shape of the human mandible in Britain. Br Dent J 1968;125:
163-9.
6. Lundstriim A. The aetiology of crowding of the teeth (based on
studies of twins and on morphological investigations) and its
bearing on orthodontic treatment (expansion or extraction). Eur
Ortbod Sot [Report] 1951:176-91.
1. Mills LF. Arch width, arch length and tooth size in young adult
males. Angle Orthod 1964;34:124-9.
8. Lundstrijm A. Changes in crowding and spacing of the teeth
with age. Dent Pratt 1969;19:218-24.
9. Fastlicht J. Crowding of mandibular incisors. AM J ORTHOD
1970;58:156-63.
10. Norderval K, Wistb PJ, Bbe OE. Manidbular anterior crowding
in relation to tooth size and craniofacial morphology. Stand J
Dent Res 1975;83:267-73.
11. Doris JM, Bernard BW, Kuftinec MM. A biometric study of
tooth size and dental crowding. AM J ORTHOD1981;79:326-36.
12. McKeown M. The diagnosis of incipient arch crowding in chil-
dren. Ni! Dent J 1981;77:93-6.
13. Howe RP, McNamara JA, O’Connor KA. An examination of
dental crowding and its relationship to tooth size and arch di-
mension. AM J ORTHOD1983;83:363-73.
14. Mills LF, Hamilton PM. Epidemiological studies of malalign-
ment, a method of computing dental arch circumference. Angle
Orthod 1965;35:244-8.
15. Van Kirk LE, Pennell EH. Assessment of malocclusion in pop-
ulation groups. Am J Public Health 1959;49: 1157-63.
16. Draker HL. Handicapping labiolingual deviations: a proposed
index for public health purposes. AM J ORTHOD1960;46:295-
305.
17. Summers CJ. The occlusal index: a system for identifying and
scoring occlusal disorders. AM J ORTHOD1971;59:552-67.
18. Moorrees CFA, Reed RB. Biometrics of crowding and spacing
of the teeth in the mandible. Am J Phys Anthropol 1954;12:
77-88.
19. Hunter WS, Priest WR. Errors and discrepancies in measurement
of tooth size. J Dent Res 1960;39:405-14.
Reprint requests to:
Mr. D. Radnzic
93 Leander Drive
Castleton
Rochdale, Lancashire
England OLl 1 2XD