Original Article

Factors Contributing to Mandibular Anterior Crowding in the

Early Mixed Dentition

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M. Özgür Sayin, DDS, PhDa; Hakan Türkkahraman, DDS, PhDa

Abstract: The aim of this study was to uncover the possible factors contributing to mandibular anterior
crowding in the early mixed dentition. Mandibular dental casts of 60 children in the early mixed dentition
were divided into two groups according to the severity of mandibular anterior crowding. The space avail-
able for the mandibular permanent incisors, total incisor width, deciduous intercanine width, deciduous
intermolar widths, permanent intermolar width, interalveolar width, and total arch length were compared
between the crowded group (CG) and noncrowded group (NCG), and correlations with crowding were
investigated. The mandibular deciduous intercanine width, mandibular deciduous intermolar widths, man-
dibular permanent intermolar width, mandibular interalveolar width, space available for the mandibular
permanent incisors, and total arch length were significantly larger in the NCG. The total width of the four
mandibular incisors did not differ significantly between CG and NCG. Significant inverse correlations were
found between crowding and available space, deciduous intercanine width, deciduous intermolar widths,
permanent intermolar width, and interalveolar width. Total incisor width was directly correlated with
crowding. No significant correlation was found between crowding and total arch length. The results of this
study suggested that individual variations play an important role in treatment planning. However, one must
not overlook arch length discrepancies and transverse discrepancies in patients with mandibular anterior
crowding. (Angle Orthod 2004;74:754–758.)
Key Words: Anterior crowding; Arch width; Mixed dentition

INTRODUCTION also had crowding in the permanent dentition, and only

11% showed complete correction. They also found that,
Although crowding is considered as the most prevalent
except for two cases, the other self-correcting cases had no
form of malocclusion,1–5 a period of slightly crowded man-
more than 0.5 mm crowding in the early mixed dentition.
dibular incisors has been accepted as a normal develop-
In another study, Lundy and Richardson10 reported that the
mental stage.6,7 When the permanent mandibular lateral in-
mean crowding of the lower incisors had decreased 0.9 mm
cisors erupt, an average 1.6 mm of additional space was
from the initial eruption of the lower permanent incisors to
required for the perfect alignment of the four mandibular
the initial eruption of the permanent canines.
incisors.6–8 This slight crowding was reported to be solved
The determination of the factors contributing to mandib-
by a slight increase in intercanine width, labial positioning
ular anterior crowding, especially in the early mixed den-
of the permanent incisors relative to the primary incisors,
tition stage, is of great importance for treatment planning.
and slight backward movement of the canines into the pri-
Some authors correlated arch dimensions with crowding.
mate space.6,7
Mills11 found that dental arches of individuals without
However, crowding of more than 1.6 mm may not be
crowding were about 4 mm wider than the crowded arches.
solved by these mechanisms. In a longitudinal study, Sanin
Sanin and Savara9 reported larger anterior and posterior
and Savara9 evaluated 150 children and reported that 89%
widths of the mandibular dental arch in children who did
of the subjects with crowding in the early mixed dentition
not have crowding in the permanent dentition. McKeown12
found a greater correlation between dental arch size and
a
Assistant Professor, Department of Orthodontics, Faculty of Den- crowding than between tooth size and crowding. Howe et
tistry, University of Suleyman Demirel, Cunur, Isparta, Turkey. al13 evaluated dental crowding in the permanent dentition
Corresponding author: M. O. Sayin, DDS, PhD, Department of
Orthodontics, Faculty of Dentistry, University of Suleyman Demirel, and reported significant differences in arch dimensions be-
Cunur, Isparta 32260, Turkey tween crowded group (CG) and noncrowded group (NCG).
(e-mail: [email protected]). Radnzic14 reported significant correlations between arch di-
Accepted: November 2003. Submitted: October 2003. mensions and the degree of crowding. Hagberg15 reported
q 2004 by The EH Angle Education and Research Foundation, Inc. that a mandibular intercanine distance of less than 26 mm

Angle Orthodontist, Vol 74, No 6, 2004 754

MANDIBULAR ANTERIOR CROWDING 755

TABLE 1. Mean Chronological Ages of the Groups

Noncrowded (n 5 30) Crowded (n 5 30)
Mean SD Min Max Mean SD Min Max P
Chronological age 9.14 0.96 7.47 11.17 8.84 0.72 7.2 10.19 .177 NSa
a
NS indicates nonsignificant.

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was associated with crowding in seven-, nine-, and 10-year-
old children. Melo et al16 reported that mandibular dental
arch length in the primary dentition was an effective dis-
criminator in separating normal and crowded cases.
On the other hand, some authors correlated tooth size
with crowding. Fastlicht17 reported significant correlation
between dental crowding and mesiodistal dimensions of
mandibular permanent incisors. Norderval et al18 reported
that the mesiodistal diameter of four mandibular incisor FIGURE 1. The space available for the mandibular permanent inci-
teeth was significantly larger in adults with slight crowding sors.
in the mandibular anterior segment.
A review of the literature indicated conflicting results
about the factors contributing to crowding. These differ-
ences may be due to variables such as the developmental
period of the study sample, differences in sample sizes, and
the methods used for measurements. Few studies have eval-
uated mandibular anterior crowding in the early mixed den-
tition. The aim of this study was to find possible factors
contributing to mandibular anterior crowding in the early
mixed dentition.
FIGURE 2. Total mandibular arch length.
MATERIALS AND METHODS
Mandibular dental casts of 60 children (29 boys, 31 girls) between the mesial surfaces of deciduous canines by divid-
referred to the Department of Orthodontics, Suleyman De- ing the dental arch into two straight line segments, the
mirel University were evaluated in this study. These sub- length of these segments was summed to give available
jects were selected according to the following criteria: space9 (Figure 1); total incisor width: the width of each
incisor was measured and summed to give total incisor
• Class I skeletal pattern;
width; crowding: total incisor width was subtracted from
• Early mixed dentition stage (fully erupted four permanent
available incisor space to calculate the severity of crowd-
mandibular incisors, deciduous canines, deciduous mo-
ing; total arch length: total mandibular arch length was
lars, and permanent first molars);
measured as segments on the right and left sides, as defined
• No congenitally missing permanent teeth or premature
by Warren and Bishara.19 For the anterior segment, mea-
loss of deciduous or permanent teeth;
surements were performed from the contact point of the
• Minimal loss of tooth dimension by caries or attrition.
permanent central incisors to the contact point between the
None of the subjects had undergone previous orthodontic deciduous canine and the first deciduous molar. For the pos-
treatment. Two groups were formed according to the se- terior segment, measurements were performed from the
verity of mandibular anterior crowding. Because 1.6 mm of contact point between the canine and first deciduous molar
mandibular anterior crowding was reported as normal at to the most distal point of the second deciduous molar. The
this stage,6–8 subjects who had anterior crowding #1.6 mm segment lengths for the right and left sides were summed
were included in the noncrowded group (NCG) and those to determine total arch length (Figure 2); intercanine width:
who had anterior crowding .1.6 mm were included in the distance between the cusp tips of mandibular deciduous ca-
crowded group (CG). Each group was composed of 30 sub- nines (Figure 3); intermolar width I: distance between me-
jects. Mean chronological ages of the groups are shown in siolingual cusp tips of mandibular first deciduous molars
Table 1. (Figure 3); intermolar width II: distance between mesio-
The following measurements were performed on each buccal cusp tips of mandibular second deciduous molars
mandibular plaster model. Available space: the space avail- (Figure 3); permanent intermolar width: distance between
able for the mandibular permanent incisors was measured mesiobuccal cusp tips of mandibular first permanent molars

Angle Orthodontist, Vol 74, No 6, 2004

756 SAYIN, TÜRKKAHRAMAN

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FIGURE 3. Arch and alveolar width measurements.
FIGURE 4. Bar graphs of the measurements.

TABLE 2. Reliability Coefficients of the Measurements

r cantly different. Bar graphs of the measurements are shown
Available space 0.9803 in Figure 4.
Total incisor width 0.9646 Available space. The space available for the mandibular
Intercanine width 0.9646 permanent incisors was significantly larger in NCG (P ,
Intermolar width I 0.9922
Intermolar width II 0.9795
.001).
Permanent intermolar width 0.9971 Total incisor width. Total width of the four mandibular
Interalveolar width 0.9934 incisors did not differ significantly between the groups.
Total arch length 0.9930 Intercanine width. Mandibular deciduous intercanine
width was significantly larger in NCG (P , .01).
Intermolar widths I and II. Mandibular deciduous inter-
(Figure 3); interalveolar width: distance between mucogin- molar widths I and II were significantly larger in NCG (P
gival junctions below the buccal grooves of the right and , .001).
left mandibular first permanent molars (Figure 3). Permanent intermolar width. Mandibular permanent in-
All the measurements were performed on plaster models termolar width was significantly larger in NCG (P , .001).
with dial caliper to the nearest 0.01 mm. All measurements Interalveolar width. Mandibular interalveolar width was
of 20 subjects were repeated two weeks later to determine significantly larger in NCG (P , .01).
measurement error. The repeatability coefficients of the Total arch length. Total arch length was significantly
measurements were shown in Table 2. Statistical compari- larger in NCG (P , .01).
son of the two groups was performed with independent Measurement correlations. Correlations of the measure-
samples t-test. Pearson correlations were examined for in- ments are shown in Table 4. Significant inverse correlations
terrelationships between crowding and all other measure- were found between crowding and available space (r 5
ments. 0.63; P , .001), intercanine width (r 5 0.37; P , .01),
intermolar width I (r 5 0.58; P , .001), intermolar width
RESULTS II (r 5 0.52; P , .001), permanent intermolar width (r 5
0.34; P , .01), and interalveolar width (r 5 0.28; P ,
Statistical comparison of the groups
.05). Total incisor width was directly correlated with crowd-
Statistical comparison of the groups is shown in Table 3. ing (r 5 0.43; P , .01). No significant correlation was
All the parameters except total incisor width were signifi- found between crowding and total arch length.

TABLE 3. t-Test Comparison of the Measurements

Noncrowded (n 5 30) Crowded (n 5 30)
Mean SD Mean SD P
Available space 22.81 1.59 20.46 1.38 .000***
Total incisor width 22.91 1.72 23.47 1.52 .181 NSa
Intercanine width 26.27 1.73 24.74 1.73 .001**
Intermolar width I 28.29 1.56 26.12 1.59 .000***
Intermolar width II 39.02 1.88 36.28 2.01 .000***
Permanent intermolar width 45.52 2.24 42.98 2.59 .000***
Interalveolar width 57.27 2.34 55.16 2.19 .001**
Total arch length 69.72 2.98 67.63 2.64 .006**
a
NS indicates nonsignificant.
** P , .01.
*** P , .001.

Angle Orthodontist, Vol 74, No 6, 2004

MANDIBULAR ANTERIOR CROWDING 757

TABLE 4. Pearson Correlation Coefficients of the Measurements occlusion with 39 adults with slight mandibular crowding
Crowding and reported no differences in intercanine widths between
r P the groups. Hagberg15 examined dental casts longitudinally
of 54 Swedish children aged seven, nine, 10, and 13 years
Available space 20.63 .000***
and associated an intercanine distance less than 26 mm with
Total incisor width 0.43 .001**
Intercanine width 20.37 .004** crowding. He also reported that a distance of 28 mm or
Intermolar width I 20.58 .000*** more had no risk for crowding. According to our findings,
Intermolar width II 20.52 .000*** mandibular deciduous intercanine width, mandibular decid-

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Permanent intermolar width 20.34 .008** uous intermolar widths I and II, mandibular permanent in-
Interalveolar width 20.28 .033*
termolar width, and mandibular interalveolar width were
Total arch length 20.17 .203 NSa
significantly larger in NCG. These findings indicated that a
a
NS indicates nonsignificant. mandibular transverse discrepancy existed in CG. In accor-
* P , .05.
** P , .01. dance with Hagberg,15 the mean intercanine width was 26.3
*** P , .001. in the NCG and 24.7 in the CG. Although we examined
patients in the early mixed dentition, our findings were in
accordance with those of Howe et al,13 Radnzic,14 and Sanin
DISCUSSION
and Savara,9 who evaluated permanent dentitions. This sug-
The term ‘‘incisor liability’’ was defined as the difference gests that arch width differences between CG and NCG can
between the amount of space needed for the incisors and be determined even in the early mixed dentition.
the amount available.6 In the mandible, because of incisor Some researchers investigated contributions of arch
liability with a mild irregularity of the mandibular incisors, length to crowding. Sanin and Savara9 reported that chil-
a mean of 1.6 mm was accepted as normal when the per- dren without crowding in the permanent dentition had more
manent incisors and first molars had erupted but the pri- available space for the emergence of the canines than chil-
mary canines and molars were retained.6–8 For this reason, dren with crowding. Radnzic14 reported that crowded arches
patients whose mandibular anterior crowding was #1.6 mm had smaller arch lengths than noncrowded or spaced arches.
were included in the NCG. Patients whose mandibular an- Melo et al16 evaluated 12 normal and 11 crowded cases at
terior crowding was .1.6 mm were included in the CG. the primary dentition stage and reported that mandibular
Patients with minimal loss of tooth dimension were se- dental arch length was an effective discriminator in sepa-
lected so as not to affect arch length measurements. A Class rating the two groups. Our results indicated that the space
I skeletal pattern was also taken into consideration for all available for the mandibular permanent incisors and total
patients so as not to affect arch dimensions. The mean ages arch length was significantly larger in NCG. Although the
of the patients in each group did not differ significantly. methods used to measure arch length and dentitional stages
This was important because of continuing growth and de- of the subjects were different, our results were in accor-
velopment. Finding the possible factors contributing to dance with those of Sanin and Savara,9 Radnzic,14 and Melo
mandibular anterior crowding in the early mixed dentition et al.16
is of great importance for further treatment planning. Some authors found differences in tooth dimensions be-
Some of the reports in the literature found differences in tween subjects with and without crowding. Norderval et al18
arch widths between patients with and without crowding. reported that the four mandibular incisor teeth had signifi-
Howe et al13 compared 50 subjects with severe crowding cantly larger mesiodistal diameters in the CG. Doris et al20
with 54 subjects with mild or no crowding and found that evaluated 80 subjects (between 11 and 18 years of age) and
mandibular arch widths were significantly larger in the reported that mesiodistal tooth size was uniformly larger in
NCG. They concluded that consideration might be given to the group with crowded arches. Howe et al13 reported that
those treatment techniques that increase dental arch length CG and NCG could not be distinguished from each other
rather than reduce tooth mass. Radnzic14 evaluated 120 on the basis of mesiodistal tooth diameters. Radnzic14 did
boys (age 13 years to 15 years 11 months) and reported not find a difference in cumulative crown widths between
that crowded arches had smaller arch widths than non- crowded and noncrowded arches but reported that cumu-
crowded or spaced arches. He suggested that expansion lative mesiodistal crown widths contributed significantly to
might occasionally be beneficial in carefully selected young dental crowding. Mills11 evaluated 230 male subjects and
patients and in the majority of cases, carefully planned ex- reported little variations between crown diameters of per-
tractions would continue to be an important part of treat- sons with and without malalignment. In accordance with
ment in the relief of primary dental crowding. Howe et al,13 our results indicated that the total width of
Sanin and Savara9 evaluated 150 children and reported four mandibular incisors did not differ significantly be-
that children without crowding in the permanent dentition tween CG and NCG.
had larger anterior and posterior widths of the mandibular Several investigators studied associations between
dental arch. Norderval et al18 compared 27 adults with ideal crowding and arch dimensions and tooth size using corre-

Angle Orthodontist, Vol 74, No 6, 2004

758 SAYIN, TÜRKKAHRAMAN

lation analysis. Mills11 reported a significant association be- However, one must not overlook arch length discrepancy
tween crowding and arch width. McKeown12 evaluated 65 and transverse discrepancy in patients with mandibular an-
children and found a greater correlation between dental arch terior crowding. For this reason, the application of a lingual
size and crowding than between tooth size and crowding. arch or lip bumper in patients with anterior mandibular
Radnzic14 reported significant correlations between arch di- crowding may be of value in the early mixed dentition.
mensions and the degree of crowding but no significant
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Angle Orthodontist, Vol 74, No 6, 2004