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Comparison of the mandibular dental and basal

arch forms in adults and children with Class I and
Class II malocclusions
Deepak Gupta, R. Matthew Miner, Kazuhito Arai, and Leslie A. Will
Ann Arbor, Mich, Boston, Mass, and Tokyo, Japan

Introduction: The mandibular arch form at the EDITOR’S COMMENT

levels of both the application point of the orthodontic
bracket and the basal bone in adults and children with
Class I malocclusion and Class II Division 1 malocclu-
sion was investigated.
Methods: One hundred thirteen pretreatment man-
dibular casts were scanned to generate a 3-dimensional
computer model of each cast. The casts were divided
into Class I and Class II Division 1 malocclusion
groups, and were further divided into adults (age, $25
years) and children (age, #18 years). Two reference
points, FA and WALA, were assigned for each tooth.
The FA and WALA arch forms were compared, and
the distances between corresponding points and interca-
nine and intermolar widths were analyzed.
Results: The mandibular intercanine FA point
widths were significantly greater in the Class II Division
1 malocclusion group than in the Class I malocclusion
group (P \0.05) and were also significantly greater
in the Class I adults than in the Class I children
(P \0.05). Both the canine FA and WALA point dis-
tances and the molar FA and WALA point distances
were moderately to highly correlated (R2 .0.55) and
highly significant (P \0.001) for all groups. The FA
and WALA curves for all groups had individual differ-
ences, especially in the premolar and molar areas.
Conclusions: The Class II Division 1 mandible is
essentially the same as the Class I mandible with respect
to basal bone and dental arch dimensions. WALA points
can be used to predict individual dental arch forms in
adults and children. Dental and basal arch forms were
not significantly different between adolescents and
adults.
Read the full text online at: www.ajodo.org,
pages 10.e1-10.e8.
Am J Orthod Dentofacial Orthop 2010;138:10-1
0889-5406/$36.00
Copyright Ó 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2010.03.016
10
When in practice, I used to meet periodically with
my laboratory personnel to review the cost of our routine
supplies: archwires, brackets, and so on. One day after
returning from a continuing education course, my labo-
ratory assistant asked why I spent time altering the shape
of nearly every archwire placed in a patient’s mouth;
after all, they could be purchased in different shapes
and sizes for more convenient use without further bend-
ing. That got me thinking, and I now realize that several
good articles from Harvard University have recently
made it easier to understand why most good clinicians
bend a new archwire to match the original arch form
before placing it in the patient’s mouth. Ronay et al
(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) used a unique methodology to evaluate
mandibular arch forms in 35 Class I patients, and Ball et
al (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) used this methodology to
evaluate mandibular arch forms in 35 Class II Division
1 patients. The only difference in this current study
was that the authors compared the Class I patients
with Class II Division 1 patients, and looked at adoles-
cents and adults. The authors concluded that a general
arch form cannot be applied to all patients with any
malocclusion for any age group. One conclusion of the
article by Ronay et al was that ‘‘Both FA and WALA
point-derived arch forms were individual and therefore
could not be defined by a generalized shape.’’
The authors of this study were quick to note, ‘‘It is
true that this study is very similar to those done by Ro-
nay and Ball. However, it was always felt that mixing
growing individuals and adults in a sample could be
problematic. With growth of the mandible, we were
not sure whether the relationship between the dental
and bony arches changes, and felt that this question
needed to be answered. This study, then, documents
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 138, Number 1
Fig 1. Mean distances between FA and WALA points
for Class I and Class II Division 1 groups, with standard
deviations and P values.
that children and adults were not found to be different in
this regard.’’
With advances in technology, it is not unrealistic
that the integration of digital models and cone-beam
computed tomography scans can provide skeletal arch
analysis to determine ultimate arch form and size. Indi-
vidualized arch forms are currently available through
several vendors. OrthoCAD’s virtual setups permit cus-
tomizing the arch form for each patient based on the pre-
treatment model. Ormco’s Insigna and SureSmile
produce archwires customized for each patient.
Q&A
Turpin: With the apparent increase in technology, do
you think the typical clinician is more or less aware
of the need to pay attention to variations in arch
form?
Will: I suspect that, when orthodontists needed to
form their own archwires, they used the dental cast
as a model and thus changed the arch form only for
a specific purpose. Now that arches are preformed
and are frequently made of a nondeformable alloy,
Gupta et al 11
Fig 2. Mean distances between FA and WALA points
for adults and children, with standard deviations and
P values.
orthodontists rarely try to adapt the arch form. I hope
that research can begin to show the precise conse-
quences of changes in arch form so that we can
optimize the stability of our treatments.
Turpin: Do you plan additional studies using this
methodology to evaluate posttreatment arch form
changes?
Will: Yes, we are planning to use this technique to
evaluate changes in arch form not only after treat-
ment but also carry it further to see what occurs after
retention.
Turpin: Will you consider the use of 3-dimensional
imaging to study arch form changes with or without
orthodontic treatment?
Will: We have begun to ‘‘translate’’ this technique to
cone-beam computed tomography images so that we
can also examine exactly where the basal bone is. We
hypothesize that different vertical positions of the
skeletal landmarks of arch form might yield different
information on arch form.