Effects of Case Western Reserve University's Transverse Analysis On The Quality of Orthodontic Treatment

ORIGINAL ARTICLE
Effects of Case Western Reserve

University's transverse analysis on the
quality of orthodontic treatment
Raweya Yehya Mostafa,a Rany M. Bous,b Mark G. Hans,b Manish Valiathan,b Garrison E. Copeland,c
and Juan Martin Palomob
Cairo, Egypt, and Cleveland, Ohio
Introduction: The purpose of this study was to evaluate the effect of using the transverse analysis developed at
Case Western Reserve University (CWRU) in Cleveland, Ohio. The hypotheses were based on the following: (1)
Does following CWRU's transverse analysis improve the orthodontic results? (2) Does following CWRU's trans-
verse analysis minimize the active treatment duration? Methods: A retrospective cohort research study was
conducted on a randomly selected sample of 100 subjects. The sample had CWRU's analysis performed retro-
spectively, and the sample was divided according to whether the subjects followed what CWRU's transverse
analysis would have suggested. The American Board of Orthodontics discrepancy index was used to assess
the pretreatment records, and quality of the result was evaluated using the American Board of Orthodontics
cast/radiograph evaluation. The Mann-Whitney test was used for the comparison. Results: CWRU's transverse
analysis significantly improved the total cast/radiograph evaluation scores (P 5 0.041), especially the buccolin-
gual inclination component (P 5 0.001). However, it did not significantly affect treatment duration (P 5 0.106).
Conclusions: CWRU's transverse analysis significantly improves the orthodontic results but does not have sig-
nificant effects on treatment duration. (Am J Orthod Dentofacial Orthop 2017;152:178-92)
T
he key to successful orthodontic treatment is thor- brought to our attention by various authors. In a classic
ough diagnosis and treatment planning. Diagnosis study, Andrews3 evaluated 120 casts of nonorthodontic
must be broad and comprehensive, and should not patients with normal occlusion and developed “the 6
overlook any aspect of the problem.1 The introduction of keys to normal occlusion,” which became a foundation
the cephalostat by Holly Broadbent2 and T. Wingate for orthodontic treatment. One of those 6 keys is the
Todd in the 1920s revolutionized the diagnostic tools, buccolingual inclination of crowns, which Andrews
by allowing us to study the skeletal and dental relation- thought was essential for harmonious occlusion.
ships in more depth, especially in the anteroposterior Furthermore, Andrews and Andrews4 studied the 6 ele-
and vertical dimensions. Since the lateral cephalogram ments to orofacial harmony and stated that maxillary
is a 2-dimensional presentation of a 3-dimensional arch width should be compatible with mandibular arch
(3D) structure, the transverse dimension was not as thor- width for optimal orofacial harmony. The importance
oughly studied and was often left out during diagnosis of the transverse dimension was further confirmed
and treatment planning. This is despite the fact that when the American Board of Orthodontics (ABO) incor-
the importance of the transverse dimension has been porated the buccolingual inclination of the posterior
teeth in the cast-radiograph evaluation, used for assess-
a
Private Practice, Cairo, Egypt. ing the quality of orthodontic treatment.5 Moreover,
Sarver and Ackerman6 discussed the importance of as-
b
Department of Orthodontics, School of Dental Medicine, Case Western Reserve
University, Cleveland, Ohio.
c
Private Practice, Cleveland, Ohio. sessing the transverse dimension for achieving an
All authors have completed and submitted the ICMJE Form for Disclosure of Po- esthetic smile. They stated that improving the transverse
tential Conflicts of Interest, and none were reported. dimension can dramatically enhance the smile by opti-
Address correspondence to: Juan Martin Palomo, Department of Orthodontics,
School of Dental Medicine, Case Western Reserve University, 2124 Cornell Rd, mizing the buccal corridors and the transverse dimen-
Cleveland, OH 44106-4905; e-mail, palomo@case.edu. sion of the smile. Kusnoto et al7 investigated the
Submitted, May 2016; revised and accepted, January 2017. orthodontic correction of transverse arch asymmetries
0889-5406/$36.00
Ó 2017 by the American Association of Orthodontists. All rights reserved. and noticed that asymmetry in the transverse dimension
http://dx.doi.org/10.1016/j.ajodo.2017.01.018 was not corrected. Also, there were no differences
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Yehya Mostafa et al 179
between growing and nongrowing responses in trans- “dentoalveolar compensation” through adjustments of
verse asymmetry correction. the buccolingual molar angulations.
McNamara8 indicated that maxillary transverse defi- Hans et al18 discussed how the evolution of imaging
ciency may be one of the most pervasive skeletal prob- introduced cone-beam computed tomography (CBCT),
lems in the craniofacial region. In a classic article, which brought us to a new era of diagnostics. It gave
Haas9 stated that the prime objective of palatal expan- us a 3D image, allowing us to study the cranium in all
sion is to coordinate the maxillary and mandibular den- 3 planes. Mostafa19 indicated that the introduction of
ture bases. Lagravere et al10 performed a meta-analysis 3D CBCT imaging is revolutionizing the orthodontic
of immediate changes with rapid maxillary expansion diagnostic philosophy. Furthermore, Palomo et al20 dis-
(RME) and found that the greatest changes after RME cussed the variety of orthodontic clinical applications of
were dental and skeletal transverse changes. A few ver- CBCT, along with the methods and clinical applications
tical and anteroposterior immediate changes were statis- of CWRU's transverse analysis. Larson21 indicated that it
tically significant, although they were clinically is the imaging of choice for comprehensive orthodontic
negligible. Furthermore, Lagravere et al11 compared treatment. Among the many applications of 3D imaging
the transverse, vertical, and anteroposterior skeletal in orthodontics that are not possible with 2-dimensional
and dental changes in adolescents receiving expansion images is a more thorough analysis of the transverse
treatment with bone-anchored maxillary expansion vs dimension, where a cross-sectional axial view allows
traditional rapid maxillary expansion. They concluded measurement of the buccolingual inclinations of the
that both expanders showed similar results. The greatest molars and canines.20,22
changes were seen in the transverse dimension; changes In 5 consecutive years, CWRU's transverse analysis
in the vertical and anteroposterior dimensions were was developed by Shewinvanakitkul,23 Evangelinakis,24
negligible.10,11 Dental expansion was also greater than Shewinvanakitkul et al,22 Karamitsou,25 Miyamoto,26
skeletal expansion.11 Copeland,27 Streit,28 and Palomo et al.20 Shewinvanakit-
In a classic article, El-Mangoury12 pointed out that kul developed a new technique to measure buccolingual
the mandibular intercanine width tended to relapse to- inclinations using CBCT. Palomo et al specified the
ward its original pretreatment value. This suggests that methods and clinical applications of CWRU's transverse
at the end of active treatment, the mandibular interca- analysis. These studies produced a reliable method to
nine width should be maintained as it was originally. measure the buccolingual inclinations of molars and ca-
In a similar vein, Housley et al13 indicated that trans- nines, and gave us their norms (Fig 1). Measuring the
verse expansion was more stable in the posterior region molar angulations according to CWRU's transverse anal-
of the mandibular dental arch than in the anterior re- ysis method was done as follows. After orienting the
gion, and that the mandibular intercanine width increase head (Fig 2), the buccolingual inclination of each maxil-
could be maintained only by fixed retention. lary first molar was measured through the angle outlined
Initially, Marshall et al14 assessed the transverse between the palatal long axis of the tooth (the line
molar movements during growth and concluded that, joining the mesiopalatal cusp tip with the palatal root
on average, the maxillary molars erupt with buccal apex) and a tangent to the inferior border of the nasal
crown torque and upright with age. Mandibular molars cavity (Fig 3).25 The buccolingual inclination of each
erupt with lingual crown torque and upright with age mandibular first molar was measured through the angle
also. These molar crown torque changes were accompa- formed between the long axis of the tooth (the line con-
nied by concurrent increases in maxillary and mandib- necting the central groove with the apex of the mesial
ular intermolar widths.14 Later, Hesby et al15 studied root) and a tangent to the inferior border of the
the transverse skeletal and dentoalveolar changes during mandible (Fig 4).22
growth and found that the transverse molar movements Mostafa29 concluded that CWRU's transverse analysis
during growth mirror the maxillary and mandibular significantly improves the orthodontic results.
cross-arch alveolar process width increases. The purpose of this study was to retrospectively test
Enlow and Hans16 discussed dentoalveolar compen- the diagnostic importance of the molar angulation
sations: the natural tendency of the teeth to maintain component of CWRU's analysis and its effect on treat-
contact and normal interarch relationships. They stated ment results by (1) evaluating the orthodontic pretreat-
that intrinsic adjustments during growth are an impor- ment and posttreatment records with CWRU's transverse
tant biologic concept, since they allow regional parts analysis, (2) assessing the pretreatment records using the
to stay in a state of functional and structural equilib- ABO discrepancy index, and (3) appraising the posttreat-
rium. Moreover, Solow17 mentioned that transverse ment study casts using the ABO cast/radiograph evalua-
skeletal jaw discrepancies are partly compensated by tion.
American Journal of Orthodontics and Dentofacial Orthopedics August 2017 Vol 152 Issue 2
180 Yehya Mostafa et al
Fig 1. CWRU's transverse analysis norms.
Fig 2. Head orientation: A, orient the line that represents the axial view so that it passes through ANS in
the sagittal view; B, locate the ANS in the axial view (point where the coronal and sagittal planes meet);
C, in the sagittal view, move the line that represents the axial view downward so that it passes through
the center of the atlas; D, go back to the axial view and rotate the line that represents the sagittal plane
around the ANS so that it passes through the center of the odontoid process.
August 2017 Vol 152 Issue 2 American Journal of Orthodontics and Dentofacial Orthopedics
Fig 3. Measuring maxillary molar angulation: A, locate the molar in the axial view, the point at which the
palatal root length is the longest in the sagittal view; B, in the sagittal view, position the line representing
the coronal slice along the mesiopalatal cusp tip and the palatal root apex; C, draw a reference line
tangent to the nasal floor in the coronal view; D, measure the inclination through the long axis of the
molar (represented by the line coming through the apex of the palatal root and the mesiopalatal
cusp tip).
Fig 4. Measuring mandibular molar angulation: A, locate the molar in the axial view, the point at which
the roots are longest in the sagittal view; B, in the sagittal view, position the coronal line along the long
axis of the molar (mesial cusp tip to mesial root apex); C, draw a reference line tangent to the inferior
border of the mandible in the coronal view; D, measure the inclination, the angle between the line pass-
ing the root apex and central fossa of the molar and the reference line.
Cangialosi et al30 introduced the discrepancy index to 1. Inclusion criteria: randomly selected subjects who
measure case complexity before treatment. It measures started orthodontic treatment in the core clinic at
objectively the following disorders: overjet, overbite, CWRU in 2010 and completed active treatment.
anterior open bite, lateral open bite, crowding, buccal 2. Exclusion criteria: incomplete pretreatment records
posterior crossbite, lingual posterior crossbite, occlusion, (pretreatment CBCT scans, study casts, intraoral and
ANB angle, IMPA, and SN-GoGn angle. The greater the extraoral photographs), incomplete posttreatment
number of these conditions in a patient, the greater records (study casts, intraoral and extraoral photo-
the complexity, the higher the score, and the greater graphs), or patients who were planned for surgery
the challenge for the orthodontist.30 at the time of posttreatment records.
Traditionally, the evaluation of orthodontic treat-
ment outcomes has been done through the subjective Table I shows the descriptive demographics of the
opinions of experienced orthodontists. In 1998, Casko sample. The sample was predominantly white, with
et al5 introduced the ABO ruler and the ABO's cast/radio- only 6 subjects from other ethnicities. The sample
graph evaluation for assessing posttreatment dental included 49 girls and 36 boys, and the predominant pre-
casts and panoramic radiographs. It is composed of the treatment age group was 12 to 13 years (42 subjects).
following 8 criteria: alignment, marginal ridges, bucco- The materials used for the study were (1) pretreatment
lingual inclination, occlusal relationships, occlusal records (pretreatment CBCT scans, study casts, intraoral
contacts, overjet, interproximal contacts, and root angu- and extraoral photographs), (2) initial treatment plans
lation. The cast/radiograph evaluation reduces subjec- and progress notes, (3) posttreatment records (posttreat-
tivity when assessing the quality of orthodontic ment CBCT scans, study casts, intraoral and extraoral
finishing and helps to evaluate cases submitted to the photographs), and (4) the ABO measuring gauge.
phase II ABO examination for board certification or The protocol was approved by CWRU's institutional
recertification. However, the root angulation category review board. The sample was divided into 2 groups on
was not measured or included in the cast/radiograph the basis of whether the subjects were treated according
evaluation score in this study. to CWRU's transverse analysis. These 2 groups “fol-
The sample was divided into 2 groups according to lowed” what the CWRU transverse analysis would have
whether the subjects were treated according to CWRU's suggested or “did not follow” the CWRU transverse anal-
transverse analysis, specifically the molar angulation ysis.
component, since the canine angulations were not In the “followed” group (n 5 46) (Fig 5), treatment
necessary for our study. This was a retrospective cohort would include RME for subjects with either 1 maxillary
study. molar having an abnormal buccolingual inclination
The expected results were that CWRU's transverse (more than 1 SD above the mean), or 1 mandibular
analysis not only improves the orthodontic results but molar having an abnormal buccolingual inclination
also minimizes the active treatment duration. If these (more than 1 SD below the mean). Furthermore, in
results are achieved, diagnostic strategies could be the “followed” group, treatment would include arch-
applied whereby the treatment plan and mechanother- wire expansion or cross elastics for subjects who had
apy are evidence-based on a clear vision of the desired at least 1 maxillary molar having an abnormal bucco-
orthodontic posttreatment outcomes, satisfying lingual inclination (more than 1 SD below the mean).
different physiologic and esthetic requisites for each
patient.
Table I. Demographics of subjects
MATERIAL AND METHODS Followed Did not follow

Variable Group n 5 46 n 5 39
A retrospective cohort research study was executed Age (y) 10-11 6 8
on the basis of a randomly selected sample from the 2-13 25 17
core clinic at CWRU. The sample consisted of 100 sub- 14-16 15 14
jects, of whom 85 met the inclusion criteria. One subject Sex Male 19 17
Female 27 22
was excluded because he was planned for orthognathic
Race White 43 36
surgery at the posttreatment time, and 14 subjects Other 3 3
were excluded for lack of adequate posttreatment re- Expander status Expander 10 2
cords. The sample was divided into 2 groups according No expander 36 37
to whether the subjects were treated according to what Transverse No crossbite 41 34
Crossbite 5 5
CWRU's transverse analysis would have suggested.
Fig 5. CWRU's transverse analysis: “followed” group. AWE, Archwire expansion.
Patients who had normal buccolingual inclinations, compensation for a transverse deficiency, which was
without a crossbite, and did not have expansion, were not addressed since the treatment plan did not include
also included in the “followed” group (Fig 5). expansion. Accordingly, the subject fell into the “did
The “did not follow” group included all subjects who not follow” group. The total final cast/radiograph eval-
did not meet any of these criteria (n 5 39) (Fig 6). uation score was 17; the maxillary left first molar
For example, patient A had a pretreatment discrep- (109 ) and mandibular right first molar (68.3 ) each
ancy index of 14 and had a maxillary left first molar scored 1 point on the buccolingual inclination aspect
with a deficient angle (91.6 ) that was in crossbite, (Fig 10). If the CWRU's transverse analysis was used,
which is lower than the norm of 100 6 4 (Fig 7). the biomechanics would have included RME, and the
This suggests that the crossbite is likely due to deficient final cast/radiograph evaluation score may have been
dental inclination and not a true transverse discrep- better.
ancy. Thus, increasing the buccal inclination could cor- The following 7 independent variables were re-
rect the crossbite. The patient was treated with corded: crossbite status, maxillary expansion, active
unilateral cross elastics and thus fell into the “fol- treatment duration, pretreatment and posttreatment
lowed” group, since his crossbite was due to a deficient ages, sex, and race. Eleven dependent variables were
maxillary molar angle and not a transverse discrepancy. measured: 4 pretreatment buccolingual inclinations
The final result (Fig 8) shows that his maxillary left and 4 posttreatment buccolingual inclinations with
molar had an angle of 102.2 , which is within the CWRU's transverse analysis, 1 dichotomized CWRU var-
normal range, and that his crossbite was alleviated. iable (followed or did not follow CWRU's transverse
The final cast/radiograph evaluation score was 17, analysis), the discrepancy index, and the cast/radiograph
and no first molar scored a point on the buccolingual evaluation score.
inclination aspect. The already existing CBCT scans used here were
On the other hand, patient B had a maxillary left taken with a CB MercuRay (Hitachi Healthcare Ameri-
first molar with excessive angulation (104.9 ), which cas, Twinsburg, OH, USA.) with custom low-dose set-
is greater than the norm (Fig 9). Moreover, the tings of 2 mA, 120 kVp, 12-in field of view, 512
mandibular first molars had deficient angles (right first slices, 0.377-mm slice thickness, resolution of
molar, 58.4 ; left first molar, 56.7 ), which are below 1024 3 1024 pixels, 12 bits per pixel, and 4096 gray
the norm of 75 . This indicates a possible dental scale.31,32 For CWRU's transverse analysis, the
Fig 6. CWRU's transverse analysis: “did not follow” group. AWE, Archwire expansion.
pretreatment buccolingual inclinations of the maxillary this study. The ABO measuring gauge was used for
and mandibular permanent first molars were the cast/radiograph evaluation scoring.5 All statistical
determined for each quadrant (as described by analyses were done with SPSS software (version 22.0;
Shewinvanakitkul et al,22 Karamitsou,25 and Mostafa29) IBM, Armonk, NY).
using Dolphin Imaging Software (version 11.8; Dolphin For intrarater reliability, the primary investigator
Imaging and Management Solutions, Chatsworth, (R.Y.M.) used CWRU's transverse analysis to measure
Calif). the buccolingual inclinations of the maxillary and
For the discrepancy index, the pretreatment records mandibular permanent first molars on 30 subjects.
were evaluated to objectively measure the complexity, This investigator also estimated the ABO's discrepancy
which included the following disorders: overjet, over- index with the pretreatment records of 30 subjects and
bite, anterior open bite, lateral open bite, crowding, gauged the cast/radiograph evaluation measurements
buccal posterior crossbite, lingual posterior crossbite, with the posttreatment orthodontic casts of 30 subjects.
occlusion, ANB angle, IMPA, SN-GoGn angle, and After 4 weeks, all of the above measurements were
other complexities. For the cast-radiograph evaluation, repeated by the same investigator.
the posttreatment dental casts were scored with the For interrater reliability, another investigator (R.M.B.)
following 7 criteria: marginal ridges, buccolingual in- measured the buccolingual inclinations of the maxillary
clinations, interproximal contacts, occlusal contacts, and mandibular first molars, as well as the ABO cast/
occlusal relationships, rotations/alignment, and over- radiograph evaluation with the posttreatment casts of
jets. The eighth component of the cast/radiograph 30 subjects. The Cronbach alpha test was used for the
evaluation—root angulation—was not measured or reliability analyses of the intrarater and interrater reli-
included in the cast/radiograph evaluation score in abilities.
Fig 7. Patient A: A, pretreatment photographs; B, pretreatment molar angulations.
Fig 8. Patient A: A, posttreatment photographs; B, posttreatment molar angulations.
To satisfy the major assumptions of parametric sta- P values were less than 0.015, indicating that the data
tistical testing, the normality of the data distribution were nonparametric in distribution. The data were
was evaluated using the Shapiro-Wilk test.33 The aspects analyzed with the independent-sample Mann-Whitney
measured were the cast/radiograph evaluation, the test, because of the nonparametric distribution.
discrepancy indexs, and active treatment duration. Their P #0.05 was used to assign statistical significance.
Fig 9. Patient B: A, posttreatment photographs; B, posttreatment molar angulations.
Fig 10. Patient B: A, posttreatment photographs; B, posttreatment molar angulations.
RESULTS discrepancy index values, and cast/radiograph evalua-

The summary of the results is presented in Tables II tions through the Cronbach alpha. The values ranged
through V. from 98.7% to 99.9% for intrarater reliability and from
Table II shows the intrarater and interrater reliability 89.2% to 95.5% for interrater reliability, indicating
values for buccolingual inclinations of the first molars, high reliability.
subjects, of whom 85 met the inclusion criteria. The

Table II. Intrarater and interrater reliabilities with the
sample was divided into 2 groups according to whether
reliability analysis
or the subjects were treated according to CWRU's trans-
Cronbach alpha verse analysis. The reason for the discrepancy between
Intrarater Interrater
the pretreatment and posttreatment sample sizes is
Variable reliability (%) reliability (%) that 14 subjects who completed active treatment did
Discrepancy index 98.7* not have adequate posttreatment records, and 1 subject
Cast-radiography evaluation 98.9* 91.0* was excluded because he was planned for orthognathic
Buccolingual molar angulations surgery at the posttreatment time.
Maxillary right permanent 99.8* 95.5*
first molars
The intrarater and interrater reliabilities (Table II)
Maxillary left permanent 99.9* 94.9* were computed. The Cronbach alpha was used because
first molars it is a strong model of internal consistency based on
Mandibular right 99.8* 89.2* the mean (absolute value) interitem correlation for all
permanent first molars possible variable pairs. Reliability is the extent to which
Mandibular left permanent 99.7* 89.6*
an experiment, test, or measuring device yields the
first molars
same results in repeated trials. However, validity is the
*Significant at P \0.0001 (2-tailed). conformity to accepted biologic principles. Thus, reli-
ability is a necessary condition for validity.34
The Shapiro-Wilk test was done to assess normal distri-
The discrepancy index values of both groups were bution for the discrepancy index, cast/radiograph evalua-
compared (Table III), and the results showed no signifi- tion, and treatment duration. The test showed significant
cant difference between the means of both groups results at a P value of less than 5%. Furthermore, the z-
(P 5 0.801). This indicates that the pretreatment case values of the skewness and kurtosis were not in the range
complexity for both groups was similar. of 1.96 to 11.96, showing that the data were not nor-
Table IV provides the descriptive statistics for the mally distributed.35 Because of the nonparametric distri-
pretreatment and posttreatment buccolingual inclina- butions, the data were analyzed with the Mann-Whitney
tions of the maxillary and mandibular permanent U test. There was no significant difference (P 5 0.801) be-
first molars, measured using CWRU's transverse anal- tween the mean discrepancy index values of those who fol-
ysis.22,24 The data show that the mean pretreatment lowed CWRU's transverse analysis and those who did not
and posttreatment angulations for the permanent follow CWRU's transverse analysis (Table III). This indicates
first molars of both groups were all within normal that the mean case complexity before treatment was not
limits. significantly different in both groups.
Table V shows the comparison between the treat- Clinicians use many clinical and radiologic indicators
ment outcomes of the 2 groups. The aspects measured to identify transverse problems, such as posteroanterior
were overall cast/radiograph evaluation, buccolingual cephalometric analysis, crowding, cross bites, buccal
component of cast/radiograph evaluation, and active corridors, arch forms, and arch widths. Our method in-
treatment duration. cludes an objective, reliable method to measure molar
The mean overall cast/radiograph evaluation score inclinations that can be added to the armamentarium
was significantly lower for the “followed” group, indi- of orthodontists to help in unmasking and identifying
cating better posttreatment results. The mean was lower possible dentoalveolar compensations for transverse de-
by 2.8 points, and the P value was 0.041. Looking sepa- ficiencies. Miner et al36 used CBCT to study the relation-
rately at the buccolingual inclination category of the ships between transverse deficiencies, molar
cast/radiograph evaluation, we found that the signifi- angulations, and crossbites. Using controls, they found
cance was accentuated, since the “followed” group that where a transverse deficiency exists without cross-
had a lower score compared with the “did not follow” bites, it is usually due to molar angulations beyond 1
group (P 5 0.001); this was highly significant. SD from the mean, exhibiting a compensation for skel-
However, the mean active treatment duration etal transverse deficiencies. Moreover, they found no
showed no significant difference between the 2 groups difference in molar angulations between the bilateral
(P 5 0.106). crossbite group and the controls, indicating no compen-
sation. For example, a maxillary molar with an excessive
DISCUSSION angle (above 1 SD) or a mandibular molar with a defi-
The data were collected for a retrospective cohort cient angle (below 1 SD) can indicate possible dental
research study; the original sample consisted of 100 compensation for a narrow maxilla, and this suggests
Table III. Independent-sample Mann-Whitney U test between CWRU's transverse analysis and the discrepancy index
Followed Did not follow
n 5 46 n 5 39
Mean 6 SD Min Max Median Mode Mean 6 SD Min Max Median Mode P value
Discrepancy index 14.5 6 7.9 3 35 14 8 14.6 6 9.3 2 45 13 6 0.801 NS
Min, Minimum; Max, maximum; NS, not statistically significant.
Table IV. Descriptive statistics for pretreatment (T1) and posttreatment (T2) buccolingual inclinations of permanent
first molars with CWRU's transverse analysis
T1 T2
CWRU transverse analysis Mean 6 SD Min Max Median Mode Mean 6 SD Min Max Median Mode
BL molar angulation Followed CWRU UR6 99.6 6 5.2 88.7 112.7 99.6 97.3 101.1 6 5.3 83.4 112.5 101.6 103.3
n 5 46
UL6 100.0 6 6.3 81.8 117.2 100.9 102.2 100.7 6 5.4 91.2 113.9 100.3 101.9
LR6 75.9 6 4.0 68.3 87.6 75.8 73.6 78.7 6 3.9 72.0 87.7 78.6 78.8
LL6 75.2 6 3.8 62.6 86.6 75.3 72.1 77.8 6 4.2 66.9 88.4 78.2 78.5
Did not follow CWRU UR6 99.9 6 5.8 88.8 112.8 100.4 102.2 101.1 6 5.1 89.2 111.8 101.3 101.3
n 5 39
UL6 103.5 6 5.0 93.3 112.1 104.9 105.3 104.0 6 5.6 89.6 118.2 102.6 109.0
LR6 74.1 6 6.0 58.4 90.9 74.4 69.8 76.3 6 5.1 64.4 87.6 76.5 75.6
LL6 72.3 6 5.9 56.7 82.1 71.8 81.9 74.6 6 4.7 65.5 84.6 73.7 73.4
Min, Minimum; Max, maximum; BL, buccolingual; UR6, maxillary right permanent first molar; UL6, maxillary left permanent first molar; LR6,
mandibular right permanent first molar; LL6, mandibular left permanent first molar.
Table V. Independent-sample Mann-Whitney U test between CWRU's transverse analysis, ABO cast-radiograph eval-
uation, bucclolingual component of the cast-radiograph evaluation, and active treatment duration
Followed Did not follow
n 5 46 n 5 39
Mean 6 SD Min Max Median Mode Mean 6 SD Min Max Median Mode P value
ABO cast-radiograph evaluation 18.7 6 5.9 7 34 18 14 21.5 6 6.2 12 39 21 21 0.041*
Buccolingual component of cast-radiograph evaluation for 2.9 6 1.7 0 7 3 2 4.6 6 2.3 1 10 5 5 0.001*
posterior teeth
Treatment duration (mo) 25 6 5.4 13 40 24 24 27.3 6 6.4 16 48 25 25 0.106
NS
Min, Minimum; Max, maximum; NS, not statistically significant.

*Statistically significant at P \0.05, using independent-sample Mann-Whitney test.
that using RME and expanding the maxilla can be bene- transverse analysis. Moreover, the significance was
ficial for a harmonious occlusion. On the other hand, a accentuated when we looked separately at the buccolin-
deficient maxillary molar angle could be a compensation gual inclination category of the cast/radiograph evalua-
for a wider maxilla, and RME should be avoided. Thus, tion, where the mean scores were significantly lower for
following CWRU's transverse analysis suggests that those who followed CWRU's transverse analysis,
some inclinations outside the mean values could be a compared with those who did not follow CWRU's trans-
compensation for a transverse discrepancy. This can be verse analysis. This indicates that following CWRU's
especially helpful for supplementing other diagnostic transverse analysis significantly improves the overall
findings when dealing with borderline cases. As evident final treatment result.
from Table V, the mean cast/radiograph evaluation However, there was no significant difference between
scores of those who followed CWRU's transverse analysis the mean active treatment durations of those who fol-
were significantly lower than the mean cast/radiograph lowed CWRU's transverse analysis and those who did
evaluation scores of those who did not follow CWRU's not. In other words, following CWRU's transverse
analysis did not significantly affect the active treatment 9. Haas AJ. Palatal expansion: just the beginning of dentofacial or-
duration. thopedics. Am J Orthod 1970;5:219-55.
10. Lagravere MO, Heo G, Major PW, Flores-Mir C. Meta-analysis of
CWRU's transverse analysis seems able to identify ab-
immediate changes with rapid maxillary expansion treatment. J
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On the basis of these results, the following conclu- dontics from Broadbent to cone-beam computed tomography.
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Effects of Case Western Reserve University's Transverse Analysis On The Quality of Orthodontic Treatment

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Effects of Case Western Reserve University's Transverse Analysis On The Quality of Orthodontic Treatment

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ORIGINAL ARTICLE

Effects of Case Western Reserve

Fig 1. CWRU's transverse analysis norms.

MATERIAL AND METHODS Followed Did not follow

Fig 5. CWRU's transverse analysis: “followed” group. AWE, Archwire expansion.

Fig 7. Patient A: A, pretreatment photographs; B, pretreatment molar angulations.

Fig 8. Patient A: A, posttreatment photographs; B, posttreatment molar angulations.

Fig 9. Patient B: A, posttreatment photographs; B, posttreatment molar angulations.

Fig 10. Patient B: A, posttreatment photographs; B, posttreatment molar angulations.

RESULTS discrepancy index values, and cast/radiograph evalua-

subjects, of whom 85 met the inclusion criteria. The

Min, Minimum; Max, maximum; NS, not statistically signiﬁcant.

Min, Minimum; Max, maximum; NS, not statistically signiﬁcant.

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