Original Article |
Corresponding author: Panchatcharam Barkavi ( barkavi.dent@gmail.com ) © 2024 Panchatcharam Barkavi, Mohamed Iqbal, Priyanka Gandhi, Harishma Sivakumar, Kavitha Mathivanan, Kothandaraman Thirivikhraman.
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Barkavi P, Iqbal M, Gandhi P, Sivakumar H, Mathivanan K, Thirivikhraman K (2024) Reliability of Moyer’s and Tanaka Johnston’s prediction methods in a non-Caucasian heterogeneous population – a cross-sectional study. Folia Medica 66(4): 521-527. https://doi.org/10.3897/folmed.66.e126997
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Introduction: Mixed dentition analyses are used to determine possible tooth-size and arch-length discrepancies during the transition from primary to permanent dentition. Prediction methods using a probability table or linear regression equation use the sum of the mesiodistal widths of mandibular permanent incisors to predict the mesiodistal width of unerupted permanent teeth. Racial and sexual variations and sexual dimorphism in tooth size have been reported. The objective of this study is to validate Moyer’s and Tanaka Johnston’s mixed dentition analyses in a contemporary South Indian population.
Materials and methods: 100 pairs of permanent dentition models belonging equally to both sexes with an age range of 12–21 years comprised the sample in which both analyses were done. The predicted width of permanent canines and premolars was compared to the actual width in the study models.
Results: There was a statistically significant difference between the two values for Moyer’s analysis in the mandibular teeth of females (p=0.04), 95% CI −0.605 to −0.969. There was a statistically significant difference between the two values for Tanaka Johnston’s analysis of maxillary teeth (p=0.001), 95% CI 0.863 to 1.370.
Conclusions: Moyer’s analysis shows a statistically significant underestimation in the mandibular arch of females. Tanaka Johston’s analysis shows a statistically highly significant overestimation in the maxilla. Both analyses cannot be reliably applied to the South Indian population.
mixed dentition analysis, non-radiographic methods, prediction methods, validity of Moyer’s prediction method, validity of Tanaka-Johnston’s prediction method
Preventive and interceptive procedures are integral to early treatment protocols in patients with favorable morphogenetic patterns. Maintaining arch length in these individuals is crucial to making sure the transition from deciduous to permanent dentition is uneventful.[
This is a retrospective, analytical, cross-sectional, record-based study, approved by the institutional review board of the Tamil Nadu Government Dental College and Hospital in Chennai. The sample is from pre-treatment maxillary and mandibular permanent dentition study models (Fig.
1. Study models with fully erupted permanent incisors, canines, premolars and first molars on both sides of maxillary and mandibular dental arches. The teeth should have reached the occlusal plane to facilitate accurate measurement.
2. Intact dentition with no proximal caries, restorations, and trauma.
3. Mesial and distal contact points of all teeth should be accessible for sliding calipers.
4. Teeth younger than 21 years of age at the beginning of the study in order to exclude the mesiodistal loss of tooth structure due to physiological attrition.
The mesiodistal width of mandibular incisors, maxillary and mandibular permanent canines, and the first and second premolars was measured using a digital Vernier caliper (0-150 mm, INSIZE with 0.01 mm resolution) (Fig.
Statistical analysis was done by IBM SPSS (IBM Corp. Released 2011.IBM SPSS Statistics for Windows, Version 20.0 Armonk, and NY: IBM Corp). Mean and SD were used to summarize the data. Means and standard deviations for the sum of the mesiodistal width of the mandibular incisors and the sum of mesiodistal width of permanent canine and premolars in a quadrant were determined. Means and standard deviations for the predicted width of permanent canines and premolars in both arches were also determined. Initially, the data was checked for normality using the Shapiro-Will test. The data was found to be normal, and therefore it was decided to use parametric tests for further comparisons. Predicted and measured values were compared using the Student’s t test. A p value of less than 0.05 was considered statistically significant.
The intra-examiner measurements showed a strong reliability with Cohen’s Kappa value of 0.859 (p=0.002) (Table
Variable | Value | P value |
Cohen’s kappa | 0.859 | 0.002* |
Statistical analysis for comparison of right side and left side mesiodistal width of canines and premolars
Arch | Side | Mean | SD | SEM | P value |
Maxilla | Left | 21.6775 | 1.074 | 0.107 | 0.952 |
Right | 21.6803 | 1.076 | 0.107 | ||
Mandible | Left | 22.2709 | 1.240 | 0.124 | 0.923 |
Right | 22.2581 | 1.241 | 0.124 |
Mean differences between the actual and predicted values of the sum mesiodistal width in the maxilla (females) (Moyer’s analysis).
Mean differences between the actual and predicted values of the sum mesiodistal width in the mandible (females) (Moyer’s analysis).
Variable | Group | Mean | SD | SEM | 95% Confidence interval of the difference | P value | ||
Lower | Upper | |||||||
Female | Maxilla | Predicted | 21.28 | 0.331 | 0.047 | −0.06714 | −0.37369 | 0.665 |
Actual | 21.35 | 1.02 | 0.146 | |||||
Mandible | Predicted | 21.28 | 0.602 | 0.086 | −0.60531 | −0.96916 | 0.04* | |
Actual | 21.88 | 1.13 | 0.161 | |||||
Males | Maxilla | Predicted | 22.27 | 0.595 | 0.086 | −0.29950 | −0.71046 | 0.151 |
Actual | 22.57 | 1.29 | 0.184 | |||||
Mandible | Predicted | 22.08 | 0.536 | 0.079 | 0.09035 | −0.24666 | 0.59 | |
Actual | 21.99 | 1.02 | 0.146 |
Mean differences between the actual and predicted values of the sum mesiodistal width in the maxilla (males) (Moyer’s analysis).
Mean differences between the actual and predicted values of the sum mesiodistal width in the mandible (males) (Moyer’s analysis).
Mean differences between the actual and predicted values of the sum mesiodistal width in the maxilla (Tanaka and Johnston’s analysis).
Mean differences between the actual and predicted values of the sum mesiodistal width in the mandible (Tanaka and Johnston’s analysis).
Variable | Group | Mean | SD | SEM | 95% Confidence interval of the difference | P value | |
Lower | Upper | ||||||
Maxilla | Predicted | 22.79 | 0.7030 | 0.070 | 0.86365 | 1.37065 | 0.001* |
Actual | 21.68 | 1.076 | 0.107 | ||||
Mandible | Predicted | 22.29 | 0.7039 | 0.070 | −0.24726 | 0.31536 | 0.81 |
Actual | 22.26 | 1.238 | 0.123 |
Non-radiographic mixed-dentition analyses to predict the sum of the mesiodistal width of unerupted permanent canines, first and second premolars are based largely on odontometric data of early white North American children of European ancestry. Racial and secular variations, sexual dimorphism exhibited by human dentition makes applicability of these norms in other populations unreliable. Several studies have been carried out in Middle Eastern, African, and European populations.[
Application of mixed-dentition analyses in a non-Caucasian, non-American population based on the sum of the mesiodistal width of mandibular permanent incisors as a predictor requires validation as the norms are Caucasian-American-based. This study was conducted with the objective of such validation in a composite South Indian population.
The salient conclusions are:
Moyer’s prediction at the 75th percentile is inaccurate to be applied for a South Indian population.
1. Moyer’s analysis shows a statistically significant underestimation in female mandibles and statistically insignificant underestimation in female maxillae and male maxillae.
2. Moyer’s analysis shows a statistically insignificant overestimation in male mandibles.
3. Tanaka and Johnston’s analysis shows a highly statistically significant overestimation in maxilla and statistically insignificant overestimation in mandible.
Both analyses cannot be reliably applied to the South Indian population, and hence there is a need to frame population-specific norms. This would require another study with a larger sample size to generate data and apply a possible regression model to make the analyses more reliable for this population.
The authors have no support to report.
The authors have no funding to report.
The authors have declared that no competing interests exist.
Panchatcharam Barkavi: conceptualization, data curation, methodology, project administration, resources, validation, visualization, writing – original draft, writing – review and editing; Mohamed Iqbal: visualization, resources, validation, writing – original draft, writing – review and editing; Priyanka Gandhi: writing – original draft, writing – review and editing; Harishma Sivakumar: writing – original draft, writing – review and editing; Kavitha Mathivanan: writing – original draft, writing – review and editing; Kothandaraman Thirivikhraman: writing – original draft, writing – review and editing.