HUCKABA’S MIXED DENTITION ANALYSIS (RADIOGRAPHIC METHOD) MOYER’S MIXED DENTITION ANALYSIS TANAKA AND JOHNSTON ANALYSIS Hixon and Oldfather’s Analysis Nance Carey’s analysis Total space analysis

1. MODEL
ANALYSIS
Presenter: Neha Bemalgi
PG (2nd year)

2. CONTENTS
▹ INTRODUCTION
▹ REQUSITES OF STUDY MODELS
▹ PARTS OF A STUDY MODEL
▹ CLASSIFICATION
▹ MIXED DENTITION ANALYSIS
• HUCKABA’S MIXED DENTITION ANALYSIS
(RADIOGRAPHIC METHOD)
• MOYER’S MIXED DENTITION ANALYSIS
• TANAKA AND JOHNSTON ANALYSIS
(1974)
2

3. ▸Hixon and Oldfather’s Analysis
(1958)
▸Nance Carey’s analysis
▸Total space analysis
▸Recent advaces.
3

4. INTRODUCTION
▸Model analysis is a three dimensional
assessment of the maxillary and mandibular
dental arches and occlusal relationships for
orthodontic diagnosis and treatment
planning.
4

5. REQUSITES OF STUDY MODELS
▸Should accurately reproduce all
the teeth and soft tissues without
any distortion.
▸Should be trimmed symmetrical
on either side.
▸Posterior surface should be
trimmed, such that when placed
on their back they should
reproduce the occlusal plane.
5

6. Parts of study models
▸Anatomic portion
▸Artistic portion
▸The ratio of the anatomic portion to
the artistic portion should be 3:1.
6

7. Maxillary model
▸Buccal cut
▸Anterior cut
▸Heel cut
7

8. Mandibular model
▸Buccal cut
▸Curve cut
▸Heel cut
8

9. 9
Model analysis
Mixed dentition analysis
Moyers analysis
Huckaba’s analysis
Nance & Careys
analysis
Tanaka Johnston
analysis
Hixon and Oldfather
analysis
Permanent dentition analysis
Ponts analysis
Bolton analysis
Ashley Howes analysis
Carey’s arch perimeter
analysis
Linder harth
analysis

10. MIXED DENTITION
ANALYSIS
10

11. TYPES OF ANALYSIS
11
REGRESSION
EQUATIONS
1. Moyers
2. Tanaka-
Johnston RADIOGRAPHIC
1. Hukaba
2. Sim
COMBINED
1. Hixon –
Oldfather
2.Nance
Carey’s
Are the Lower Incisors the Best Predictors for the Unerupted Canine and Premolars
Sums? An Analysis of a Peruvian Sample
Eduardo Bernabé, Angle Orthod. 2005 Mar;75(2):202-7

12. ▸To evaluate the amount of space
available in the arch for
succeeding permanent teeth and
necessary occlusal adjustments.
▸Early treatment is becoming
increasingly popular in orthodontics,
it is imperative that mixed dentition
analysis is accurately done before
any orthodontic treatment is offered
(Cunat,1982 , Proffit and Fields,
2000)
12

13. ▸Space analysis involves
comparison between amount of
space available for alignment of
teeth and amount of space
required to place them in correct
position.
▸The conditions requiring early
attention are those in which there
is disparity between amount of
dental arch space and amount of
tooth material which should be
accommodated (Huckaba, 1964)
13

14. ▸An accurate mixed dentition
space analysis is one of the
important criteria in determining
whether treatment plan may
involve serial extraction,
guidance of eruption , space
maintenance, space regaining or
just periodic observation of
patients ( Bishara and Jakobsen,
1998)
14

15. AVERAGE MESIODISTAL
WIDTH OF TEETH
▸Anterior to first permanent molar
15

16. MOYER’S ANALYSIS
▸Robert Moyers in 1971.
▸Measuring one group of teeth, that
is mandibular incisors, it is
possible to make a prediction on
size of other groups of teeth with a
fair degree of accuracy
16

17. Why mandibular incisors??
▸Erupt early in a mixed dentition.
▸Less variable and more reliable
than maxillary incisors.
▸Maxillary incisors are not used
since they show too much
variability in size and their
correlation with other groups of
teeth are of lower predictive value
17

18. Procedure in mandibular arch
18
Measure M-D width of all 4 lower incisors &
sum it up.
Measure distance distal to lateral incisor
to mesial of first permanent molar.
Based on M-D widths of 4 mandibular incisors, the
width of erupting permanent canine & premolar are
predicted using the moyers prediction chart.
75% probability level is considered
reliable.
The predicted tooth size of 3,4 & 5 is compared with
arch length available for them to determine the
discrepancy.

19. Probablity table for predicting
the sizes of unerupted Cuspids
and bicuspids
19

20. ▸Record the estimated values for
the combined cuspids and
bicuspids widths in the mixed
dentition analysis form for both
sides and each arch.
▸Compute the amount of space
left in the arch for molar
adjustment by subtracting the
estimated Cuspid and Bicuspids
size from the measured space
available in the arch
20

21. Procedure in maxillary
arch
▸Similar to that of mandibular arch with 2
exceptions.
1. A different probability chart is used for
predicting upper cuspid and bicuspid sum.
2. Allowance must be made for overjet
correction when measuring the space to be
occupied by the aligned incisors.
▸NOTE: Remember that width of lower
incisors are used to predict upper cuspid
and bicuspid widths21

22. Probablity table for
prediction.
22

23. Advantages
▸Minimal systematic error.
▸Specific equipment or
radiographic projection not
required.
▸Can be used for both arches.
▸Can be done in mouth or casts.
▸Equal reliability if done by a
beginner or a expert.23

24. Disadvantages
▸Overpredicts the tooth size, hence it
may promote a borderline case into
extraction case.
▸Was developed in Caucasian
populations, therefore other still
needs to be tested in different
ethnicities.
▸Requires a special chart for
prediction.
24

25. DRAWBACKS
▸If differential skeletal growth
occurs, alterations in molar
relationship will result and mixed
dentition analysis predictions must
be altered accordingly.
▸Inability to reflect the position of
incisors with respect to skeletal
profile.
▸Mixed dentition analysis is a 2
dimensional visualization of a
complex 3 dimensional problem25

26. Umapathy et al., (2015)
▸New regression equation for
Bangalore population for predicting
the mesiodistal diameters of the
unerupted permanent canines and
premolars.
▸400 randomly selected subjects with
age group 13-16years, intact
dentition and no malocclusion.
▸The mesiodistal widths of the
incisors, canines and premolars of
both arches were measured.26

27. ▸It was found that 50% is more
applicable to boys and 75% to girls.
▸The canine premolar segment in
both arches is statistically larger in
men than in women (p<0.05)
27

28. Tanaka and Johnston
Method (1974)
▸Dr Marvin M Tanaka & Dr Lysle E
Johnston.
▸Measure greatest mesiodistal width
four permament mandibular
incisors.
▸Predict the size of the combined
width of the mandibular and
maxillary cuspid and bicuspid by the
use of Tanaka and Johnston's
formula.
28

29. ▸Available arch length = total arch
length - sum of incisors +predicted
width.
▸+ value – space surplus
▸- value – space deficient.
29

30. ▸The equation is most accurate
when widths of mandibular
canines and premolars is between
21-23mm.
▸And maxillary canine and
premolars is between 22-24mm.
30

31. Inference:
▸The predicted tooth size is
compared with the arch length
available, so as to determine
the discrepancy.
▸If predicted value > available
arch length = Crowding.
31

32. ▸Specifically different regression
equations were derived and simplified
for the size prediction of maxillary and
mandibular canines and premolars in
Asian American population:
▸Maxillary : Y= 8.2+0.6(X)
▸Mandibular : Y= 7.5+ 0.6(X)
X- MDW of 4 mandibular incisors in mm.
Y – MDW of canines and premolars in one
quadrant in mm.
32
Lee-Chan S, Jacobson BN, Chwa KH, Jacobson RS. Mixed
dentition analysis for Asian-Americans. Am J Orthod
Dentofacial Orthop. 1998;113(3):293-299.

33. Huckaba’s analysis
▸Recommended by Huckaba.G.W
in 1964.
▸He uses both study casts and
radiographs for determining
width of unerupted tooth.
▸This can be done by measuring
an object that can be seen both in
radiograph and on cast, to
compensate for the enlargement
of radiographic image.33

34. ▸Y1 = X1 X Y2
X2
Y1 - Actual width of unerupted premolar.
X1 - Actual width of primary molar.
X2 - Apparent width of primary molar.
Y2 - Apparent width of unerupted premolar
34

35. ▸Accuracy of this method of
determining depends on the quality
of the radiographs and their position
in the arch.
▸This technique can be used in
maxillary and mandibular arches for
all ethnic groups
35

36. Hixon and Oldfather’s
Analysis (1958)
36
MD width of mandibular central and lateral are
obtained from the cast.
Width of premolars from IOPA with paralleleing
technique is obtained.
Add the width of central, lateral along with the width of
unerupted premolars of one particular side.
Estimated sum total width of cuspids and bicuspids
of that particular side is obtained from chart.
Measured sum width of incisors and bicuspids has a
corresponding sum width of cuspids and premolars in
the chart.

37. 37
Incisors + bicuspids cuspids + bicuspids
41 children of age group 7yrs, 6months to 11 years
were considered for this study.

38. Probability table constructed – using the
formula
▸y = 0.6931+ 1.0386 x
▹y= predicted sum of the unerupted
canine and premolar
▹x= sum of the widths of the
mandibular central incisors and the
unerupted 1st and 2nd premolar
38
Estimation Of The Sizes Of Unerupted Cuspid And Bicuspid
Teeth E. H. Hixon, D.D.S., M.S.;R. E. Oldfather, D.D.S., M.S.
Angle Orthod (1958) 28 (4): 236–240.

39. Inference:
▸The predicted tooth size is
compared with the arch length
available, so as to determine
the discrepancy.
▸If predicted value > available
arch length = Crowding
39

40. Nance Carey’s analysis
▸This is similar to arch perimeter analysis
of permanent dentition.
▸Measure the mesio - distal width of the
erupted permanent teeth.
▸Measure width of each unerupted teeth
cuspids and bicuspids (3,4,5) from intra
oral periapical radiographs
40

41. ▸Total width of all teeth in each
quadrant will indicate space required
to accommodate the permanent
teeth.
▸Using brass wire, measure the
perimeter.
▸Compare the space required and
space available to arrive at the arch
length discrepancy
41

42. 42
Type Degree Management
mild 0-2mm Inter proximal stripping
of primary teeth
moderate Less than 5mm
-3mm or less
-3 -5mm
-Tipping of tooth
adjacent to lost space –
due to premature loss of
tooth – removable
appliance therapy
-Fixed orthodontic
management
severe More than 5mm -Generalized arch
expansion
-Removal of selected
permanent teeth
Paul S. Casamassimo, John R. Christensen, Henry W. Fields. Examination ,
Diagnosis and Treatment Planning. In: Jimmy R. Pinkham, Paul S.Casamassimo,
Dennis J. McTigue, Henry W. Fields, Arthur J. Nowak. Pediatric Dentistry,
Infancy through Adolescence, 4th edn, Elsevier, 2005; 477-512.

43. TOTAL SPACE ANALYSIS
▸Leven Merrifield, 1988.
▸Divided into three parts
• Anterior
• Middle
• Posterior
43

44. Tweeds analysis
▸Dr. Charles H Tweed developed
diagnostic facial triangle.
44

45. 45

46. ANTERIOR AREA
46
Anterior Area
(space required)
On cast:
Measure mandibular
incisor widths + canine
width radiographically.
Cephalometric correction:
• FMIA was taken into
consideration
• The incisors were repositioned
and the difference in the actual
and proposed FMIA is
determined.
• The difference in angulation is
multiplied by 0.8 to get the
difference in mm.

47. 47

48. ▸Measure the Z angle of
Merrifield and add the
cephalometric correction to it.
▸If the corrected Z angle is
greater than 80 the mandibular
incisor angulation was modified
as necessary.
▸If corrected angle is <75 then
incisor angulation should still be
modified.
48

49. • Soft tissue analysis:
▸If the lip thickness is greater than
chin thickness the difference is
determined and multiplied by 2
and added to the space required.
49

50. MIDDLE AREA
▸Space required: MDW of the 1st
permanent molar of the cast + width of
unerupted premolar from IOPA.
▸Curve of spee, the deepest point between
the flat surface and the occlusal surface
is measured on both sides.
Depth on right side+ depth on left side+0.5
2
▸Space available:
50

51. POSTERIOR AREA
▸Space required:
X = Y-X╵
Y╵
X- estimated value of 3rd molar
Y- actual size of permanent mandibular
1st molar.
X╵- Wheelers value of 3rd molar
Y╵- Wheelers value of 1st molar
51

52. ▸Space available: On a lat.ceph
measure the distance between a
tangent to distal surface of first molar
to ramus of mandible.
▸Estimated increase is 3mm/year
which means 1.5mm/year on each
side, until 14yr in boys and 16 yrs in
girls.
▸Discrepancy : Space available- space
required.
▸This tells us about where exactly the
discrepancy is present.52

53. BOSTON UNIVERSITY
APPROACH
▸By Gianely at Boston University.
▸MDW of permanent mandibular canines and premolars
=MDW of primary mandibular canine + 2(MDW of
primary mandibular first molar)
53

54. ▸Nuvvula S et al (2016) attempted to predict the
canine and premolar dimensions, in the
contemporary population, using BU approach and
compare with the values obtained using Tanaka-
Johnston (T/J) approach.
▸Age range of 7-11 years with presence of all
permanent mandibular incisors and primary
maxillary and mandibular canines and first molars
were included in the study.
▸Statistically significant (p = 0.00) positive correlation (r = 0.52-
0.55) was observed between T/J and BU approaches. A statistically
significant (p = 0.00) strong positive correlation (r = 0.72-0.77) was
observed among girls, whereas boys showed a statistically
nonsignificant weak positive correlation (r=0.17-0.42) based on
gender.
54
Nuvvula S, Vanjari K, Kamatham R, Gaddam KR. Primary Dentition Analysis:
Exploring a Hidden Approach. Int J Clin Pediatr Dent. 2016;9(1):1-4. doi:10.5005/jp-
journals-10005-1323

55. OTHER STUDIES
▸Nourallah et al, reported that sum of lower
central incisors and upper first molars had
highest prediction value for SPCP.
▸Legovic et al (2013), developed multiple
linear regression equations (MLRE) with
higher prediction values (determination
coefficient between 62% and 72%) when they
also considered the buccolingual tooth size.
55
Nourallah, A. W., D.Gesch, M. N.Khordaji, and C.Spliet. New regression equations for predic
canines and premolars in a contemporary population.
Angle Orthod 2002. 72:216–221.

56. ▸G Anitha (2016), Evaluated the
applicability of Moyers (50 and 75
percentile) and Tanaka and Johnston
(TJ) mixed dentition analysis in a
sample of children from north
eastern part of Karnataka, India.
▸A sample of 100 patients (50 males
and 50 females) in the age range of
13 to 15 years.
▸The recorded values were subjected
to ANOVA test and pearsons
coefficient test.
56
Dhanu G , G Anitha , Havale R , SP Shrutha. Evaluation of the reliability of
mixed dentition analysis on a sample population from the Northeastern part of

57. ▸The results showed that both tanaka Johnston
analysis and 75% moyers pedictibility chart
over estimated the width of canine and
premolars.
▸Regression equations were developed after
regression analysis,
For mandibular teeth, Y = 1.760 + 0.880 (X)
For maxillary teeth, Y = 7.875+0.620 (X)
X – sum of mandibular incisors.
Y- sum of canine and premolars.
57

58. NAMITHA RAMESH et al., (2014)
▸Conducted a study to evaluate the
reliability of Tanaka and Johnston
and Moyer’s (75th percentile) mixed
dentition prediction methods in
Kodava population sample, to
formulate regression equations for
predicting the mesiodistal widths of
unerupted canines and premolars
and to construct probability tables
for the Kodava population.
58
Ramesh N, Reddy MS, Palukunnu B, Shetty B, Puthalath U. Mixed
dentition space analysis in kodava population: a comparison of two
methods. J Clin Diagn Res. 2014;8(9):ZC01-ZC6.
doi:10.7860/JCDR/2014/10001.4777

59. ▸Dental models of 30 male and 30
female Kodava subjects (age range
is 16 - 23 yr) were used.
▸The actual teeth measurements were
then statistically compared with the
predicted values derived from the
Tanaka and Johnston’s equations
and Moyers probability tables at the
75th percentile.
59

60. Estimated equations for combined
boys and girls,
Maxillary Y = 12.25 + 0.39 (X)
Mandibular Y = 10.20 + 0.45 (X)
60

61. ▸Both Tanaka Johnston and
Moyers overestimated the actual
measurements, but…
▸The percentage of overestimation
for Tanaka Johnston was more
than Moyers.
61

62. Vikasini et al., (2015)
▸Conducted a study to determine
the most reliable mixed dentition
analysis method for Nalgonda
population with 60 boys and 60
girls of age 13-16years.
▸Seven different mixed dentition
analyses were performed which
include Bachmann’s, Gross and
Hassund’s, Trankmann et al.,
Camilo et al., Legovic et al.,
Tanaka–Johnston and Moyer’s
methods were compared.62

63. ▸The correlation coefficient r was
highest for Moyer’s mixed
dentition analysis with a value of
0.957 and 0.979 in the
mandibular and maxillary arch.
▸Conclusion: Moyer’s mixed
dentition analysis was found to
be the most reliable method for
both boys and girls of Nalgonda
population of all the 7 methods
compared.
63

64. RECENT ADVANCES
IN MODEL ANALYSIS
64

65. Cast analysis by E Models/
3D Digital Models

66. Advantages:
▸More accurate
▸Easy to use
▸Other features:
• Detects arch form
• Determines asymmetric arch.
• Rotations.
66

67. 67