valoraciÓn de los mÉtodos de anÁlisis de denticiÓn mixta

359Revista Facultad de Odontología Universidad de Antioquia - Vol. 25 N.o 2 - Primer semestre, 2014

VALORACIÓN DE LOS MÉTODOS DE ANÁLISIS DE DENTICIÓN MIXTA DE MOYERS Y TANAKA-JOHNSTON, EN LA PREDICCIÓN DEL DIÁMETRO

MESIODISTAL DE CANINOS Y PREMOLARES NO ERUPCIONADOS1

ASSESSMENT OF MOYERS AND TANAKA-JOHNSTON MIXED DENTITION ANALYSES FOR THE PREDICTION OF MESIODISTAL DIAMETERS OF

UNERUPTED CANINES AND PREMOLARS

PAOLA MARÍA BOTERO2, DIANA P. CUESTA3, SANDRA AGUDELO4, CATALINA HINCAPIÉ4 CAROLINA RAMÍREZ4

RESUMEN. Introducción: el objetivo de esta investigación fue valorar si los métodos de Moyers(M) percentil (p) 75, p85, p95 y Tanaka-Johnston(TJ), usados para predecir el diámetro mesiodistal de caninos y premolares no erupcionados, sobreestiman o subestiman el diámetro de sus respectivos sucedáneos. Métodos: estudio de evaluación tecnológica diagnóstica en 56 modelos de yeso de escolares de Medellín, clase I esquelética, incisivos, caninos y bicúspides permanentes erupcionados, seguidos desde 6 a 12 años de edad. Se midió el diámetro mesiodistal de los dientes y se aplicaron los métodos predictivos de Tanaka-Johnston, Moyers p75, p85, p95. Se comparó el valor predicho y el real, utilizando la SUXHED�W�6WXGHQW�UHODFLRQDGD�\�OD�GH�:LOFR[RQ��/D�UHSURGXFLELOLGDG�GH�ORV�PpWRGRV�VH�FDOFXOy�FRQ�ORV�FRH¿FLHQWH�GH�FRUUHODFLyQ�LQWUDFODVH��&&,��,&��\�HO�QLYHO��GH�DFXHUGR�FRQ�ORV�OtPLWHV�%ODQG�\�$OWPDQ�DO��Resultados:�HQ�HO�DUFR�VXSHULRU�VH�REVHUYDURQ�GLIHUHQFLDV�VLJQL¿FDWLYDV�con el valor real en las mediciones de T-J y Mp95. En arco inferior todos los métodos fueron diferentes del valor real (p > 0,05), excepto Mp75. La reproducibilidad fue mayor en arco superior con T-J, seguido de Mp85; en el arco inferior el método de Mp75 tuvo mejor reproducibilidad, seguido GH�0S��(Q�DUFR�VXSHULRU�VH�HQFRQWUy�TXH�7�-�VREUHHVWLPD�OD�PHGLFLyQ�UHDO�HQ�SURPHGLR��PP��,&��\�HQ�HO�DUFR�LQIHULRU�0S��VREUHHVWLPD�HQ��,&��Conclusión: el mejor método predictivo para el arco superior es el de Tanaka-Johnston, y para el arco inferior es el de Moyers al percentil 75, aunque ambos sobreestiman el valor real, presentan adecuada reproducibilidad.

Palabras clave: predicción; reproduciblidad; diente no erupcionado.

Botero PM, Cuesta DP, Agudelo S, Hincapié C, Ramírez C. Valoración de los métodos de análisis de dentición mixta de Moyers y Tanaka-Johnston en la predicción del diámetro mesiodistal de caninos y premolares no erupcionados. Rev Fac Odontol Univ Antioq 2014; 25(2):359-371.

RECIBIDO: ENERO 22/2013-ACEPTADO: OCTUBRE 22/2013

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ABSTRACT. Introduction: the objective of this study was to determine whether the methods of Moyers (M) percentile (p) 75, p85, p95 and Tanaka-Johnston (TJ), used in the prediction of the mesiodistal diameter of unerupted canines and premolars, either overestimate or underestimate their respective succedaneous diameter. Methods: diagnostic technology assessment in 56 plaster models of schoolchildren from Medellin, with class I skeletal and permanent erupted incisors, canines, and bicuspids, with follow-ups from 6 to 12 years of age. The teeth mesiodistal diameter was measured by the predictive methods of Tanaka-Johnston and Moyers p75, p85, p95. The predicted and actual values were evaluated by means RI�UHODWHG�6WXGHQW¶V�W�WHVW�DQG�:LOFR[RQ�WHVW��7KHVH�PHWKRGV¶�UHSURGXFLELOLW\�ZDV�FDOFXODWHG�E\�LQWUDFODVV�FRUUHODWLRQ�FRHI¿FLHQW��,&&��&,��DQG� WKHLU� OHYHO�ZDV�FDOFXODWHG�XVLQJ�%ODQG�$OWPDQ�� OLPLWV��Results:� LQ� WKH�XSSHU�DUFK�� VLJQL¿FDQW�DFWXDO� YDOXH�GLIIHUHQFHV�ZHUH�REVHUYHG�with the T-J and Mp95 measurements. In the lower arch, the values of all the methods were different to the actual value (p > 0.05), except Mp75. Reproducibility was higher in the upper arch with T-J, followed by Mp85; in the lower arch, Mp75 was the method with the best reproducibility, IROORZHG�E\�0S��,Q�WKH�XSSHU�DUFK��7�-�RYHUHVWLPDWHV�WKH�DFWXDO�PHDVXUHPHQW�E\��PP�LQ�DYHUDJH��&,��DQG�LQ�WKH�ORZHU�DUFK�0S��RYHUHVWLPDWHV�E\��&,��Conclusion: the best predictive method for the upper arch is Tanaka-Johnston, and for the lower arch, Moyers at the 75th percentile; although both methods overestimate the actual value, they show adequate reproducibility.

Key words: prediction; reproducibility, unerupted tooth.

Botero PM, Cuesta DP, Agudelo S, Hincapié C, Ramírez C. Assessment of Moyers and Tanaka-Johnston mixed dentition analyses for the prediction of mesiodistal diameters of unerupted canines and premolars. Rev Fac Odontol Univ Antioq 2014; 25 (2):359-371.

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SUMBITTED: JANUARY 22/2013-ACCEPTED: OCTOBER 22/2013

360

VALORACIÓN DE LOS MÉTODOS DE ANÁLISIS DE DENTICIÓN MIXTA DE MOYERS Y TANAKA-JOHNSTON, EN LA PREDICCIÓN DEL DIÁMETRO MESIODISTAL DE CANINOS Y PREMOLARES NO ERUPCIONADOS

Revista Facultad de Odontología Universidad de Antioquia - Vol. 25 N.o 2 - Primer semestre, 2014

INTRODUCCIÓN

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INTRODUCTION

Dental crowding is one of the most frequent

problems in the general population. It is described

as the discrepancy between tooth size and arch

perimeter.1 This discrepancy is characterized by a

lack of coincidence in the anatomical interproximal

contact points of erupted teeth, by teeth being unable

to erupt, or by doing so in an ectopic manner.1

Adequate diagnosis of dentoalveolar discrepancy

and early treatment are pivotal in preventing occlusal

alterations that complicate future treatments in

permanent dentition. Besides clinical analysis,

patients with mixed dentition require model

analysis as part of the necessary data to establish a

diagnosis. The method of mixed dentition analysis

predicts the mesiodistal size of permanent canines

and premolars and is a diagnostic tool that allows

to quantify crowding and to predict dentoalveolar

discrepancy by identifying the available and

necessary space for teeth not yet erupted.2

There are several prediction methods based

on models, x-rays, and a combination of both.

Radiographic methods based on lateral periapical

and 45° cephalic x-rays are the most accurate3-5 but

they require more time and special equipment and

are therefore less practical.6, 7 On the contrary, non-

radiographic methods are based on correlations and

linear regression equations with prediction tables.8, 9

The accuracy of these methods has been questioned

when applied to racial or ethnic groups other than

the population in which they originated.2, 3, 10, 11

Moyers analysis,10 a non-radiographic method,

uses mesiodistal diameter of four permanent

lower incisors, measured in plaster models,

and a prediction table for non-erupted canines and

premolars, with percentiles ranging from 50 to 95 for

361

ASSESSMENT OF MOYERS AND TANAKA-JOHNSTON MIXED DENTITION ANALYSES FOR THE PREDICTION OF MESIODISTAL DIAMETERS OF UNERUPTED CANINES AND PREMOLARS


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American children. Percentile 75 is recommended

when applying the analysis in different populations,

while percentiles 85 and 95 may overestimate the

actual value, since they have more accurate ranges.11,

12 On the other hand, the Tanaka-Johnston analysis7

uses the same reference from the four permanent

incisors but establishes a constant and a formula

based on a predictive model of an equation to be

applied on each arch.

Recognizing the estimation error of each method,

as well as biological and environmental factors

associated with the impact of the various socio-

cultural customs, inevitably decreases the

theoretical accuracy of Moyers and Tanaka-

Johnston prediction methods in Colombian

populations.13-15 Several authors have conducted

studies to compare prediction methods and

actual results in different populations, in order to

determine if the methods really work and which

the most accurate is.8, 16-22 Some of these studies

have shown, for example, that the Tanaka-Johnston

method underestimates actual tooth size, while the

Moyers method can be effectively used in different

percentiles for both sexes, with a certain degree of

overestimation.

6HYHUDO� VWXGLHV� KDYH� VKRZQ� FRHI¿FLHQWV� RI�correlation differences among diverse ethnic

groups,10, 22 with results ranging from –0.01 to

3 mm.16, 17, 19, 23, 24 Clinically, overestimation in each

arch may generate serial extractions in patients

ZLWK�VNHOHWDO�FODVV�,��DGHTXDWH�SUR¿OH�DQG�PRGHUDWH�crowding (4 to 7 mm).17, 22 Finally, the combination

of both methods has been proven to be more

accurate.5, 13, 18

The objective of this study is to determine whether

the methods of Tanaka-Johnston and Moyers,

applying the 75, 85 and 95 percentiles to predict

the mesiodistal diameter of unerupted canines and

premolars, either overestimate or underestimate the

diameter of their respective succedaneous.

362



MÉTODOS

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METHODS

This was a diagnostic technology assessment on 139

schoolchildren from Medellin, presenting skeletal

class I, with permanent incisors and erupted canines

and bicuspids. The students were monitored since

they were 6 until the age of 12 years by another

study conducted at Universidad de Antioquia, for

which a signed informed consent was obtained from

each participant.21 The patients’ models were made

annually (by a single operator, with a standardized

technique, using an irreversible hydrocolloid and

plaster stone type III, according to the manufacturer’s

instructions). Patients participated in promotion,

prevention, and restorative procedures to help them

remain healthy, and were not subjected to orthodontic

treatment during the time of the study.21

A convenience sample of 56 kids (112 pairs of

models, 2 pairs per patient) was chosen from

the group of 139 schoolchildren, as they met the

following inclusion criteria: good plaster model

conditions, absence of air bubbles or broken teeth,

WKH�¿UVW�PRGHO��REWDLQHG�IURP�HDFK�SDWLHQW�DW�LQLWLDO��mixed, or intertransitional dentition stages, should

have at least two central and one lower lateral

incisor fully erupted, and for the second model the

patient should be in the early permanent dentition

stage, with canines and bicuspids fully erupted in

one of the two sides of each arch (upper and lower).

Models were used to measure the mesiodistal

GLDPHWHU�RI� WKH�IROORZLQJ� WHHWK��XSSHU�FDQLQH��¿UVW�upper premolar, second upper premolar, lower central

LQFLVRU��ORZHU�ODWHUDO�LQFLVRU��ORZHU�FDQLQH��¿UVW�ORZHU�premolar, and second lower premolar, at the point

of maximum mesiodistal diameter, using a digital

electron microscope with an accuracy of 0.001 mm

(Leitz, Germany) at Universidad EAFIT metrology

laboratory (Medellín, Colombia), according to the

international system of units (SI). Three replicates

363



/DV�PHGLFLRQHV�IXHURQ�UHDOL]DGDV�SRU�XQ�VROR�RSHUDGRU�

H[SHUWR�HVWDQGDUL]DGR��6ROR�VH�PLGLHURQ�ORV�GLHQWHV�GHO�

ODGR�GHUHFKR�GH�FDGD�DUFR�\�VX�PHGLGD�GXSOLFDGD�SDUD�

DPERV�ODGRV��GHELGR�D�TXH�HVWXGLRV�SUHYLRV�PXHVWUDQ�

TXH�QR�H[LVWHQ�GLIHUHQFLDV��HVWDGtVWLFDPHQWH�VLJQLÀFD-

WLYDV��HQWUH�HO� WDPDxR�GHQWDO�GHO� ODGR�GHUHFKR�\�HO� L]-

TXLHUGR��HQ�XQ�PLVPR�SDFLHQWH��

3RVWHULRUPHQWH�VH�OOHYy�D�FDER�OD�SUHGLFFLyQ�GH�FDQLQRV�\� ELF~VSLGHV�� DSOLFDQGR� ORV� DQiOLVLV� GH� 7DQDND�-RKQVWRQ�\� 0R\HUV�� FRQ� SHUFHQWLO� �� FRQ� EDVH� HQ� ODV�PHGLFLRQHV� REWHQLGDV� GHO� SULPHU� PRGHOR� GH� FDGD�SDFLHQWH��\�FXPSOLHQGR�SDVR�D�SDVR�OR�VXJHULGR�SRU�ORV�DXWRUHV�GH�GLFKR�DQiOLVLV��

Análisis estadístico

6H�KL]R�XQ�DQiOLVLV�XQLYDULDGR�SDUD�GHVFULELU�ODV�PHGLGDV�GH�IUHFXHQFLD�GH�ORV�YDORUHV�UHDOHV�\�SUHGLFKRV��\�VX�YD-ULDFLyQ�FRQ�OD�DSOLFDFLyQ�GHO�PpWRGR�GH�0R\HUV��SHUFHQ-WLOHV��\��\�GH�7DQDND�-RKQVWRQ�

6H�DSOLFy�OD�SUXHED�GH�.ROPRJRURY�6PLUQRY�FRQ�FRUUHF-FLyQ�GH�/LOOLHIRUV��SDUD�HYDOXDU�OD�GLVWULEXFLyQ�QRUPDO�GH�ODV�YDULDEOHV�FRQWLQXDV��6H�UHDOL]y�XQ�DQiOLVLV�ELYDULDGR�SDUD�FRPSDUDU�HO�YDORU�SUHGLFKR�\�HO�UHDO�FRQ�FDGD�Pp-WRGR��XWLOL]DQGR� OD�SUXHED�GH�W�6WXGHQW�UHODFLRQDGD�R� OD�SUXHED�GH�:LOFR[RQ��VHJ~Q�OD�GLVWULEXFLyQ�GH�OD�YDULDEOH�

6H�FDOFXOy�HO�FRHÀFLHQWH�GH�FRUUHODFLyQ�LQWUDFODVH�&&,�\�VX�LQWHUYDOR�GH�FRQÀDQ]D�GH��SDUD�HYDOXDU�OD�UHSURGXFLEL-OLGDG��DVt�FRPR�HO�&RHÀFLHQWH�GH�/LQ��FRQFRUGDQFLD��HQWUH�FDGD�XQR�GH�ORV�PpWRGRV�SUHGLFWLYRV��7DQDND�-RKQVWRQ�\�0R\HUV��\�HO�YDORU�UHDO�PHGLGR�HQ�GHQWLFLyQ�SHUPDQHQWH��(O�PDUJHQ�GH�DFXHUGR�HQWUH�ORV�PpWRGRV�VH�GHWHUPLQy�FRQ�ORV� OtPLWHV�GHO��%ODQG�\�$OWPDQ�26�3DUD� LQWHUSUHWDU� OD�UHSURGXFLELOLGDG��VH�XWLOL]y�HO�FULWHULR�GH�$OWPDQ��DVt��SREUH��DFHSWDEOH��PRGHUDGD��\��EXHQD��HQWUH��\��\�H[FHOHQWH�FXDQGR�HUDQ�YDORUHV�PD\RUHV�D��\�KDVWD��/RV�YDORUHV�QHJDWLYRV�IXH-URQ�LQWHUSUHWDGRV�FRPR�LJXDOHV�D��(O�software�67$7$�Y��IXH�XWLOL]DGR�SDUD�HO�DQiOLVLV�HVWDGtVWLFR�

per measurement were performed in order to

provide validity to the study, and the average of the

three measures was used. The measurements were

performed by a single standardized skilled operator.

Only the teeth on the right side of each arch were

measured and their values were duplicated for both

sides, since previous studies have shown that there

DUH�QR�VLJQL¿FDQW�VWDWLVWLFDO�GLIIHUHQFHV�LQ� WHUPV�RI�size of the right and left sides in the same patient.20, 25

Prediction of canines and bicuspids was performed

by means of the analyses of Tanaka-Johnston and

Moyers, with 75, 85, 95 percentile, based on the

PHDVXUHPHQWV�REWDLQHG�IURP�WKH�¿UVW�PRGHO�RI�HDFK�patient, carefully following the steps suggested by

the creators of each method.7, 9

Statistical analysis

Univariate analysis was conducted in order to

describe the measures of frequency of predicted

and actual values and their variation after applying

the methods of Moyers (75, 85 and 95 percentiles)

and Tanaka-Johnston.

The Kolmogorov-Smirnov test with Lilliefors’

correction was used to evaluate the normal

distribution of continuous variables. A bivariate

analysis was performed to compare predicted and

actual values with each method, using the related

Student’s t test or Wilcoxon test, according to the

distribution of the variable.

,QWUDFODVV� FRUUHODWLRQ� FRHI¿FLHQW� �,&&�� DQG� LWV�FRQ¿GHQFH�LQWHUYDO�RI��ZHUH�FDOFXODWHG�LQ�RUGHU�WR� DVVHVV� UHSURGXFLELOLW\�� DQG� /LQ¶V� FRHI¿FLHQW�(concordance) was also calculated between each of the predictive methods (Tanaka-Johnston and Moyers) and the actual value in permanent dentition. The limit of agreement between the methods ZDV� FDOFXODWHG� ZLWK� %ODQG�$OWPDQ� �� OLPLWV�26

To interpret reproducibility, Altman’s criterion ZDV� XVHG� DV� IROORZV�� SRRU� �� DFFHSWDEOH� (0.21-0.40), moderate (0.41 and 0.60), good (between 0.61 and 0.80), and excellent values were those higher than 0.80 up to 1.00.27 Negative values were those equal to 0.0. The STATA v.9.0 software was used for statistical analysis.

364



RESULTADOS

'H�ORV��PRGHORV�VHOHFFLRQDGRV��HUDQ�GH�SDFLHQWHV�GH�VH[R�IHPHQLQR��\��GH�VH[R�PDVFXOLQR��$O�FRPSDUDU� ORV�YDORUHV�GH�SUHGLFFLyQ�FRQ�HO�YDORU�UHDO�GH�ORV�GLHQWHV�SHUPDQHQWHV�SDUD�HO�DUFR�VXSHULRU��VH�HQ-FRQWUDURQ�GLIHUHQFLDV�HVWDGtVWLFDPHQWH�VLJQLÀFDWLYDV�HQ�OD�SUHGLFFLyQ�GH�0R\HUV�S��YDORU�S� ��PDJQLWXG�GH� OD�GLIHUHQFLD��\�SDUD�7DQDND�-RKQVWRQ��YDORU� S� � �� PDJQLWXG� GH� OD� GLIHUHQFLD�� 0LHQWUDV�TXH�HQ�HO�DUFR�LQIHULRU�QLQJ~Q�PpWRGR��FRQ�H[FHSFLyQ�DO�GH�0R\HUV�S��S� ��PDJQLWXG�GH�OD�GLIHUHQFLD��PRVWUy�GLIHUHQFLDV�HVWD-GtVWLFDPHQWH�VLJQLÀFDWLYDV��WDEOD��

RESULTS

Of the 56 chosen models, 39 were of female patients

��DQG��RI�PDOH�SDWLHQWV� �� ,Q�FRPSDULQJ�prediction values and actual values of permanent teeth in

WKH�XSSHU�DUFK��VWDWLVWLFDOO\�VLJQL¿FDQW�GLIIHUHQFHV�ZHUH�found in Moyers p95 prediction (p = 0.004, magnitude

of difference: 22.10-23.10) and Tanaka-Johnston

prediction (p = 0.008, magnitude of difference: 21.99-

22.97). In terms of the lower arch, no method showed

VWDWLVWLFDOO\�VLJQL¿FDQW�GLIIHUHQFHV��ZLWK�WKH�H[FHSWLRQ�of Moyers p75 (p = 0.090, magnitude of difference:

21.00-22.30) (table 1).

Tabla 1. Descripción de las mediciones de los dientes según diferentes métodos de predicción

MétodoArco superior Arco inferior

Promedio (D. E.) Mediana (RIQ) T Student Valor P Promedio (D. E.) Mediana (RIQ) T Student Valor P

7DQDND�-RKQVWRQ��

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0R\HUV�S��

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0R\HUV�S��

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9DORU�UHDO�� - �� -

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Table 1. Description of teeth measurements according to different prediction methods

MethodUpper arch Lower arch

Average (S. D.) Median (RIQ) Student’s t p value Average (S. D.) Median (RIQ) Student’s t p value

7DQDND�-RKQVWRQ��

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0R\HUV�S��

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365



(O�PpWRGR�GH�7DQDND�-RKQVWRQ�PRVWUy�PD\RU�UHSURGXFL-ELOLGDG�HQ�HO�PD[LODU��FRQ�XQ�&&,�GH��,&��VHJXLGR�GH�0R\HUV�S��FRQ�XQ�&&,�GH��,&��WDEOD��(O�SRUFHQWDMH�GH�FRQFRU-GDQFLD�IXH�UHDOL]DGR�XVDQGR�HO�FRHÀFLHQWH�GH�/LQ��VLHQ-GR�PD\RU�SDUD�7DQDND�-RKQVWRQ��\�0R\HUV�S��/D�PD\RU�UHSURGXFLELOLGDG��HQWUH�HO�YDORU�UHDO�\�HO�YDORU�SUHGLFKR��IXH�HQ�HO�DUFR�LQIHULRU�SDUD�0R\HUV�S��&&,� � �� ,&�� SRUFHQWDMH� /LQ� ��\�0R\HUV�S��&&,� ��,&��SRUFHQWDMH�/LQ� ��WDEOD��

(O�PpWRGR�GH�0R\HUV�VXEHVWLPD�HO�YDORU�UHDO��FRQ�XQD�GLIHUHQFLD� GH� ��PP�\� ��PP�SDUD� S�� HQ� HO�DUFR� VXSHULRU�� 3RU� HO� FRQWUDULR�� 7DQDND�-RKQVWRQ� \�0R\HUV�S��VREUHVWLPDQ�HO�YDORU�UHDO��FRQ�GLIHUHQFLDV�GH��PP�\��PP�UHVSHFWLYDPHQWH��

The Tanaka-Johnston method showed greater

reproducibility in the maxillary, with an ICC of 0,611

�� &,� �� IROORZHG� E\� 0R\HUV� S��ZLWK�DQ�,&&�RI��&,��WDEOH�2). The percentage of concordance was calculated

XVLQJ�/LQ¶V�FRHI¿FLHQW��ZLWK�KLJKHU�YDOXHV�IRU�7DQDND�-RKQVWRQ� �� DQG� 0R\HUV� S�� 7KH�highest reproducibility between the actual value and

the predicted value occurred in the lower arch using

0R\HUV�S��,&&� ��&,��/LQ¶V�SHUFHQWDJH� ��DQG�0R\HUV�S��,&&� ��CI 0.185-0.760, Lin’s percentage = 55.4) (table 2).

Moyers method underestimates the actual value, with

a difference of 0.576 mm and 0.238 mm for p85 in

the upper arch. On the contrary, Tanaka-Johnston

and Moyers p95 overestimate the actual value, with

differences of –0.333 mm and –0.379 mm respectively.

Tabla 2.�&RHÀFLHQWHV�GH�FRUUHODFLyQ�LQWUDFODVH�\�OtPLWHV�GH�DFXHUGR�GHO��GH�OD�GLIHUHQFLD��HQWUH�HO�WDPDxR�UHDO�HUXSFLRQDGR�\�HO�YDORU�GH�OD�SUHGLFFLyQ�GHO�WDPDxR�

GH�ORV�GLHQWHV�FDQLQRV�\�SUHPRODUHV�QR�HUXSFLRQDGRV

Método CCI21 (IC95%) &RHÀFLHQWH�GH�/LQ Diferencia promedio (D,S) Límites de acuerdo del 95% Bland y Altman

Arco superior

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0R\HUV�S��

Arco inferior

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0R\HUV�S��

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0R\HUV�S��

Table 2.�,QWUDFODVV�FRUUHODWLRQ�FRHI¿FLHQWV�DQG��OLPLWV�RI�DJUHHPHQW�RI�WKH�GLIIHUHQFH�EHWZHHQ�WKH�DFWXDO�HUXSWHG�VL]H�DQG�WKH�SUHGLFWHG�YDOXH�

RI�WKH�VL]H�RI�QRQ�HUXSWHG�FDQLQHV�DQG�SUHPRODUV

Method ICC 21 (95% CI) /LQ·V�&RHIÀFLHQW Mean difference (S. D.) Bland-Altman 95% limits of agreement

Upper arch

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Lower arch

7DQDND�-RKQVWRQ �� ²�� ²��

0R\HUV�S�� ²�� ²��

0R\HUV�S�� ²�� ²��

0R\HUV�S�� ²�� ²��

366



3DUD�HO� DUFR� LQIHULRU�� DPERV�PpWRGRV�VREUHVWLPDURQ�HO�YDORU� UHDO� GH� ORV� GLHQWHV� SHUPDQHQWHV�� GRQGH� 7DQDND��-RKQVWRQ�PRVWUy�OD�PD\RU�FDQWLGDG�GH�VREUHVWLPDFLyQ��FRQ�XQD�GLIHUHQFLD�HQ�WDPDxR�GHQWDO�GH��PP��VH-JXLGR�SRU�0R\HUV�S��FRQ�XQD�GLIHUHQFLD�SURPHGLR�GH��PP��WDEOD��

&XDQGR�HO�YDORU�SUHGLFKR�HQ�HO�PD[LODU�REWHQLGR�PHGLDQ-WH�HO�PpWRGR�GH�7DQDND�-RKQVWRQ�HV�FHUFDQR�D��PP��VH�FRQVLGHUD�TXH�H[LVWH�XQD�SHUIHFWD�FRQFRUGDQFLD�FRQ�HO� YDORU� UHDO�� 6L� HO� YDORU� SUHGLFKR� HVWi� SRU� HQFLPD� GH� ��PP��VH�FRQVLGHUD�TXH�HO�PpWRGR�VREUHHVWLPD�HO�YD-ORU�UHDO��SRU�HO�FRQWUDULR��VL�HO�YDORU�HV�PHQRU��VH�HVWD-EOHFH�XQD�VXEHVWLPDFLyQ��ÀJXUD��0R\HUV�S��PXHV-WUD�XQD� WHQGHQFLD�VLPLODU��FXDQGR�HO�YDORU�SUHGLFKR�HV��PP�SDUD�OD�PDQGtEXOD��ÀJXUD��

Figura 1. 'LIHUHQFLD�GH�ODV�PHGLFLRQHV�GH�7DQDND�-RKQVWRQ�UHVSHFWR�DO�DFXHUGR�

SHUIHFWR�GH��HQ�DUFR�VXSHULRU

Figura 2. 'LIHUHQFLD�GH�ODV�PHGLFLRQHV�GH�0R\HUV�S��UHVSHFWR�DO�DFXHUGR�SHU-

IHFWR�GH��HQ�DUFR�LQIHULRU

In the lower arch, both methods overestimated the

actual value of permanent teeth, and Tanaka-Johnston

showed the greatest amount of overestimation, with

a difference in tooth size of –0.652 mm, followed by

Moyers p85, with an average difference of –0.645

mm (table 2).

When the predicted value obtained in the maxilla

using the Tanaka-Johnston method is close to 23

mm, there is perfect concordance with the actual

value. If the predicted value is above 23 mm,

the method is considered to overestimate the

DFWXDO� YDOXH�� E\� FRQWUDVW�� LI� WKH� YDOXH� LV� ORZHU��XQGHUHVWLPDWLRQ� LV� FRQVLGHUHG� �¿JXUH� ��0R\HUV�p75 shows a similar tendency when the predicted

YDOXH�LV��PP�LQ�WKH�PDQGLEOH��¿JXUH��

Figure 1. 'LIIHUHQFH�RI�7DQDND�-RKQVWRQ�PHDVXUHPHQWV�LQ�UHODWLRQ�

WR�WKH��SHUIHFW�DJUHHPHQW�LQ�WKH�XSSHU�DUFK�

Figure 2. 'LIIHUHQFH�RI�0R\HUV�S��PHDVXUHPHQWV�LQ�UHODWLRQ�WR�WKH�

��SHUIHFW�DJUHHPHQW�LQ�WKH�ORZHU�DUFK

367



DISCUSIÓN

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/RV�UHVXOWDGRV�GHO�HVWXGLR�RULJLQDO�GH�7DQDND�-RKQVWRQ�PXHVWUD�TXH�ORV�LQFLVLYRV�FHQWUDOHV�LQIHULRUHV�WLHQHQ�XQD�FRUUHODFLyQ� GH� U2 � �� SDUD� FDQLQRV� \� SUHPRODUHV�VXSHULRUHV��\�GH�U2 ��SDUD�FDQLQRV�\�SUHPRODUHV�LQIHULRUHV��(VWRV�UHVXOWDGRV�HVWiQ�GH�DFXHUGR�FRQ�ORV�GH�%DOODUG�\�:LOO\H��U2 ��/RV�FRHÀFLHQWHV�GH�FRUUHOD-FLyQ�OLQHDO��XVDGRV�SDUD�FRPSDUDU�ORV�YDORUHV�UHDOHV�FRQ�ORV� SUHGLFKRV�� VROR� HVWLPDQ� DVRFLDFLRQHV� HQWUH� HOORV��SHUR�QR�HYDO~DQ�VX�UHSURGXFLELOLGDG��&RUUHODFLRQHV�GH�U2

��\�U2 ��IXHURQ�REWHQLGDV��SRU�HO�SUHVHQWH�HVWXGLR��SDUD�HO�PpWRGR�GH�7DQDND��-RKQVWRQ�SDUD�HO�DUFR�VXSHULRU�H�LQIHULRU��UHVSHFWLYDPHQWH��(VWD�FRUUHODFLyQ�HV�PiV�EDMD�TXH�OD�HQFRQWUDGD�HQ�HO�HVWXGLR�RULJLQDO��

(O�JUDGR�GH�VXEHVWLPDFLyQ�\�VREUHHVWLPDFLyQ�SXEOLFDGD�HQ�OD�OLWHUDWXUD�SXHGH�VHU�HVWDGtVWLFDPHQWH�VLJQLÀFDWLYD��SHUR�FOtQLFDPHQWH�LUUHOHYDQWH��6LQ�HPEDUJR��XQD�GLIHUHQ-FLD�GH��PP�SXHGH�VHU�FOtQLFDPHQWH�VLJQLÀFDWLYD�HQ�ORV�FDVRV�HQ�ORV�TXH�VH�GHEH�WRPDU� OD�GHFLVLyQ�GH�UHDOL]DU�XQD� H[WUDFFLyQ� VHULDGD� HQ� SDFLHQWHV� FRQ� DSLxDPLHQWR�PRGHUDGR��(Q�HO�SUHVHQWH�HVWXGLR��HO�PpWRGR�PiV�UHSURGXFLEOH�SDUD�HO�DUFR�VXSHULRU��PRVWUy�XQD�VREUHVWL-PDFLyQ�GH��PP�\�XQD�VXEHVWLPDFLyQ�GH��PP�SDUD�HO�ODGR�GHUHFKR��3DUD�HO�DUFR�LQIHULRU��HO�PpWRGR�FRQ�PD\RU�UHSURGXFLELOLGDG�PRVWUy�XQD�VREUHHVWLPDFLyQ�GH��PP�\�XQD�VXEHVWLPDFLyQ�GH��PP�SRU�ODGR�

(VWXGLRV� SUHYLRV�� TXH� KDQ� DSOLFDGR� ORV� PpWRGRV� GH�0R\HUV� \� 7DQDND�-RKQVWRQ� HQ� GLIHUHQWHV� SREODFLRQHV��KDQ�FRPSDUDGR�VXV�UHVXOWDGRV�XVDQGR�HO�FRHÀFLHQWH�GH�FRUUHODFLyQ�OLQHDO�GH�3HDUVRQ��\�VXV�UHVXOWDGRV�KDQ� GHWHUPLQDGR� HO� JUDGR� GH� DVRFLDFLyQ� HQWUH� GRV�YDULDEOHV� FXDQWLWDWLYDV� VLQ� GHÀQLU� OD� GHSHQGHQFLD� HQWUH�HOODV�� (VWH� PpWRGR� QR� HV� DGHFXDGR� SDUD� GHWHUPLQDU�

DISCUSSION

The results of this study show that Moyers

and Tanaka-Johnston mixed dentition analyses

overestimate the actual value of permanent teeth. The

best tooth size prediction method for the upper arch

is Tanaka-Johnston, while Moyers p75 is the best for

WKH�ORZHU�DUFK��HYHQ�WKRXJK�WKH\�RYHUHVWLPDWH�DFWXDO�values, they show high reproducibility (table 2).

Results of the original Tanaka-Johnston study show

that lower central incisors have a correlation of r2 =

0.625 for upper canines and premolars, and r2 = 0.648

for lower canines and premolars. These results agree

with those of Ballard and Willye (r2 = 0.64). Linear

FRUUHODWLRQ�FRHI¿FLHQWV��XVHG�WR�FRPSDUH�SUHGLFWLRQV�and actual values, only estimate the associations

between them but do not evaluate reproducibility. In

this study, correlations of r2 = 0.603 and r2 = 0.468

were obtained with the Tanaka-Johnston method

in the upper and lower arch, respectively. This

correlation is lower than that of the original study.7

The degree of underestimation and overestimation

UHSRUWHG�LQ�WKH�OLWHUDWXUH�PD\�EH�VWDWLVWLFDOO\�VLJQL¿FDQW�but clinically irrelevant. However, a difference of 2

PP� FDQ� EH� FOLQLFDOO\� VLJQL¿FDQW� LQ� FDVHV� LQ� ZKLFK�the decision for a serial extraction in patients with

moderate crowding extraction must be taken.17, 28 29

In the present study, the most reproducible method

for the upper arch showed an overestimation of 2.10

mm and an underestimation of 1.43 mm on the right

side. In the lower arch, the method with the highest

reproducibility showed 2.02 mm overestimation and

1.59 mm underestimation on each side.

Previous studies applying the methods of Moyers

and Tanaka-Johnston in different populations have

FRPSDUHG�WKHLU�UHVXOWV�E\�XVLQJ�3HDUVRQ¶V�FRHI¿FLHQW�of linear correlation6, 16, 20, 29-31 and their results have

determined the degree of association between two

TXDQWLWDWLYH�YDULDEOHV�ZLWKRXW�GH¿QLQJ�GHSHQGHQFH�between them. This method is not suitable to

368



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([LVWHQ� GLIHUHQFLDV� HQWUH� ORV� LQVWUXPHQWRV� XVDGRV� SDUD�ODV�PHGLFLRQHV� GH� ORV� WDPDxRV� GHQWDOHV� HQ�PRGHORV� HQ�ORV� GLIHUHQWHV� HVWXGLRV� UHSRUWDGRV�� OR� TXH� KDFH� GLItFLO� OD�FRPSDUDFLyQ� HQWUH� HOORV�� 0R\HUV�� HQ� VX� LQYHVWLJDFLyQ�RULJLQDO�� HPSOHy� XQ� PLFURVFRSLR� ySWLFR� �2SWRFRP�� 7DQDND�-RKQVWRQ�HPSOHDURQ�XQ�FDOLEUDGRU�GH�YHUQLHU��FRQ�XQD�SUHFLVLyQ�GH��PP��%LVKDUD�HPSOHy�XQ�FRPSiV�GH�GREOH�SXQWD22�H�,QJHUYDOO�XQ�FDOLEUDGRU�GHVOD]DQWH�23�PLHQWUDV�RWURV�XVDURQ�FDOLEUDGRUHV�GLJLWDOHV�FRQ�SUHFLVLRQHV�YDULDEOHV�HQWUH��\��PP��(Q�HO�SUHVHQWH�HVWXGLR��VH� HPSOHy� XQ� PLFURVFRSLR� GLJLWDO� FRQ� XQD� SUHFLVLyQ� GH��PP��FRQ�HO�REMHWLYR�GH�HYLWDU�HO�GHVJDVWH�GHO�PRGHOR�GXUDQWH� ODV�PHGLFLRQHV� D� UHSHWLFLyQ� \� DVt� REWHQHU� PHMRU�SUHFLVLyQ�� /DV� GLIHUHQFLDV� HQWUH� ORV� LQVWUXPHQWRV� SXHGHQ�FUHDU�YDULDFLRQHV��DO�FRPSDUDU�ORV�GLIHUHQWHV�HVWXGLRV�\��SRU�WDQWR��YDULDELOLGDG�HQ�ORV�UHVXOWDGRV�

&XDQGR�VH�DSOLFDQ�GLIHUHQWHV�PpWRGRV�HQ�OD�PD\RUtD�GH�ORV� HVWXGLRV�� VH� HQFXHQWUDQ� UHVXOWDGRV� GLVWLQWRV�� 8QD�VXEHVWLPDFLyQ�GHO�WDPDxR�UHDO�GH�ORV�GLHQWHV�IXH�HQFRQ-WUDGD�DO�DSOLFDU�HO�PpWRGR�GH�0R\HUV�S��VREUHVWL-PDFLyQ23�\�VXEHVWLPDFLyQ2�IXHURQ�HQFRQWUDGRV�DO�XVDU�HO�PpWRGR�GH�7DQDND�-RKQVWRQ�

/D� PRUIRORJtD� GHQWDO� \� HO� WDPDxR� GH� ORV� GLHQWHV� HVWiQ�GHWHUPLQDGRV� JHQpWLFDPHQWH�� SRU� OR� WDQWR��HVWDEOHFHU� OD� DSOLFDFLyQ� \� UHSURGXFLELOLGDG� GH� ORV�DQiOLVLV�GH�GHQWLFLyQ�PL[WD�HQ�GLIHUHQWHV�SREODFLRQHV�HV�QHFHVDULR�� (Q� HO� HVWXGLR� UHDOL]DGR� SRU� 3DUGR� HW�DO�� VH� HQFXHQWUD� TXH�� DO� DSOLFDU� DQiOLVLV� H[WUDQMHURV� HQ�SREODFLyQ� FRORPELDQD�� VH� DXPHQWD� HO� HUURU� GHO� DQiOLVLV�HQWUH�XQ��D��31�/DV�FDUDFWHUtVWLFDV�UDFLDOHV�SURYHHQ�KHWHURJHQLFLGDG�HQWUH�ORV�LQGLYLGXRV�\�SXHGHQ�LQÁXHQFLDU�HO�WDPDxR�GHQWDO��([LVWHQ�YDULDFLRQHV�FXDQGR�VH�DSOLFDQ�ORV�DQiOLVLV�GH�GHQWLFLyQ�PL[WD�HQ�SREODFLRQHV�FRQ�GLIHUHQWHV�RUtJHQHV�pWQLFRV��6LQ�HPEDUJR��KD\�TXH�WHQHU�HQ�FXHQWD�TXH� OD�PXHVWUD�GHO�SUHVHQWH�HVWXGLR� IXH�SRU�FRQYHQLHQFLD��OR�TXH�OLPLWD�OD�FRPSDUDFLyQ�FRQ�RWURV�HVWXGLRV�� 3RU� OR� WDQWR�� ORV� UHVXOWDGRV�REWHQLGRV� GH� HVWH�JUXSR�GH� HVFRODUHV�GHPXHVWUD�TXH�H[LVWHQ� VXE�R� VREUH�HVWLPDFLRQHV�TXH�JHQHUDUtDQ�HUURUHV�HQ�OD�SUHGLFFLyQ�GHO�WDPDxR�GHQWDO�\�XQD�GLVFUHSDQFLD�FRQ�HO�HVSDFLR�H[LVWHQWH�

determine reproducibility or the correlation among

measures22 like the ones taken in the present study.

There are differences among the tooth size

measurement instruments within the models used in

WKH�UHSRUWHG�VWXGLHV��PDNLQJ�LW�GLI¿FXOW�WR�FRPSDUH�them. In his original project, Moyers used an optical

microscope (Optocom).10 Tanaka-Johnston used a

Vernier scale with 0.05 mm precision.7 Bishara used

a double bar compass22�DQG�,QJHUYDOO�D�VOLGH�JDXJH�23

other researchers used digital calipers with varying

precision ranging from 0.01, 0.02 to 0.03 mm.17, 25, 31, 32

In the present study, we used a digital microscope with

0.001 mm precision in order to avoid model wear

during the repeated measurements and to obtain

better accuracy. Differences among the instruments

can produce variations when comparing the different

studies, and therefore variability in the results.

When different methods are used in most studies,

a variety of results are obtained. Underestimation

of teeth actual size occurred when applying the

Moyers p75 method,7, 10, 20 but overestimation23 and

underestimation2 were found using the Tanaka-

Johnston method.

Dental morphology and teeth size are genetically

GHWHUPLQHG�14, 15, 23, 29 therefore, it is necessary to

establish application and reproducibility of mixed

dentition analyses in different populations.3, 6, 17, 20 In

the study by Pardo et al, they found out that applying

foreign analyses in Colombian population increases

HUURU�DQDO\VLV�IURP��WR��31 Racial characteristics

create heterogeneity among individuals and can

LQÀXHQFH�WRRWK�VL]H�14, 17, 20, 33-35 Variations occur when

applying mixed dentition analyses in populations

with different ethnic backgrounds.15, 33, 36 However, it

should be noted that this study’s sample was selected

for convenience, which limits the comparison with

other studies. Therefore, the results among this group

of schoolchildren show over- and underestimations

that may generate tooth size prediction errors and

discrepancies with the existing space.

369



CONCLUSIONES

6H�SXHGH�FRQFOXLU�TXH�HO�XVR�GH�XQ�VROR�PpWRGR�GXUDQ-WH�OD�SUiFWLFD�FOtQLFD��SXHGH�LQGXFLU�JUDQGHV�YDULDFLRQHV�HQ� OD�SUHGLFFLyQ�GHO� WDPDxR�GHQWDO� \�� SRU� WDQWR�� VH� UH-FRPLHQGD�OD�FRPELQDFLyQ�GH�ORV�PpWRGRV�GH�0R\HUV�\�7DQDND�-RKQVWRQ�HQ�OD�SREODFLyQ�HVWXGLDGD��SDUD�REWHQHU�PHMRU� UHSURGXFLELOLGDG�� WHQLHQGR�HQ�FXHQWD�TXH�DPERV�VREUHVWLPDQ� HO� YDORU� UHDO�� 7DQDND�-RKQVWRQ� VH� VXJLHUH�SDUD�HO�DUFR�VXSHULRU�\�0R\HUV�S��SDUD�HO�LQIHULRU�

AGRADECIMIENTOS

$JUDGHFHPRV�D� OD�'RFWRUD�/LEEH�0DULDFD�\�FRODERUDGR-UHV��TXLHQHV�UHDOL]DURQ�HO�HVWXGLR�HQ�OD�8QLYHUVLGDG�GH�$Q-WLRTXLD��\�FX\D�PXHVWUD�IXH�XVDGD�HQ�HO�SUHVHQWH�HVWXGLR�

CONFLICTOS DE INTERÉS

/RV�DXWRUHV�GHFODUDPRV�TXH�HO�PDQXVFULWR�HV�RULJLQDO��QR�KD�VLGR�SXEOLFDGR�SUHYLDPHQWH�\�QR�VH�HQFXHQWUD�HQ�SURFHVR�GH�HYDOXDFLyQ�HQ�QLQJXQD�RWUD�UHYLVWD��(O�HVWXGLR�WXYR�ÀQDQFLDFLyQ�SURSLD�SRU�SDUWH�GHO�&RPLWp�SDUD�HO�'H-VDUUROOR�GH�OD�,QYHVWLJDFLyQ��&21$',��GH�OD�8QLYHUVLGDG�&RRSHUDWLYD� GH�&RORPELD�� \� VH� FXPSOLy� FRQ� WRGRV� ORV�UHTXLVLWRV�SDUD�GLFKD�ÀQDQFLDFLyQ��

CORRESPONDENCIA

3DROD�%RWHUR&DOOH��VXU�1��$$��2ÀFLQD��0HGHOOtQ��&RORPELD7HOpIRQR��)D[��&RUUHR�HOHFWUyQLFR��SERWHURP#JPDLO�FRP

CONCLUSIONS

It can be concluded that using a single method

during clinical practice may induce large

YDULDWLRQV� LQ� WRRWK� VL]H� SUHGLFWLRQ�� LW� LV� WKHUHIRUH�recommended to combine Moyers and Tanaka-

Johnston methods in the studied population in

order to obtain better reproducibility, taking into

account that both methods overestimate actual

values. Tanaka-Johnston is suggested for the upper

arch and Moyers p75 for the lower arch.

ACKNOWLEDGMENTS

We thank Dr. Libbe Mariaca and collaborators, who

conducted the study at Universidad de Antioquia

and whose sample was used in the present study.

CONFLICTS OF INTEREST

The authors declare that the manuscript is

original, has not been previously published and

is not under evaluation in any other journal. The

study was funded by Comité para el Desarrollo

de la Investigación (CONADI), of Universidad

Cooperativa de Colombia, and met all the

requirements for such funding.

CORRESPONDING AUTHOR

Paola Botero

Calle 4 sur No. 43AA-26. Suite 206.

Medellin, Colombia

Phone: 57 4 3210479

Fax: 57 4 3116939

Email: [email protected]

370



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