Orthodontics

NECESSITY FACTORS AND PREDICTORS OF DENTAL CROWDING

TREATMENT

Georgeta ZEGAN1, Cristina Gena DASCLU2, Radu Bogdan MAVRU3,

Daniela ANISTOROAEI4
1
Assoc. Prof., PhD, Dept. Surgery, Faculty of Medical Dentistry, Gr. T. Popa U.M.Ph. Iai
2
Lecturer, PhD, Dept. Preventive Medicine and Interdisciplinarity, Faculty of Medicine, Gr. T. Popa U.M.Ph. Iai
3
Assist. Research, PhD Student, Dept. Surgery, Faculty of Medical Dentistry, Gr. T. Popa U.M.Ph. Iai
4
Lecturer, PhD, Dept. Surgery, Faculty of Medical Dentistry, Gr. T. Popa U.M.Ph. Iai
Corresponding author: [email protected]

Abstract functional or local causes [15]. The frequency of

The aim of the study was to identify the significant
this anomaly is quite high among people, varying
necessity and predictive factors of dental crowding treat- between 5-80% [69], thus representing the most
ment, on 422 subjects (165 boys and 257 girls) from the frequent cause for which patients address the
North-East part of Romania. Correlations have been estab- specialist.
lished between dental crowding and age, dentition, Angle
class of malocclusions, the etiological factors, types and Orthodontic therapy makes use of a large
modalities of treatments, and types of orthodontic appli- range of appliances for solving such problems
ances employed (p<0.05). Application of the chi-square test and for creating space on the arches: dental
provided the necessity factors for the types of dental
crowding treatments (p<0.001), while the Hosmer-Leme-
alignment, occlusion and facial aesthetics. The
show test permitted to establish the predictive factors for therapeutical means at hand, differing as a
the interceptive orthodontic treatment (maxillary expan- function of the causes and severity of dental
sion for mild and moderate crowdings), the corrective ort- crowding, represent a priority for the dental
hodontic treatment (maxillary expansion and orthodontic
extraction for dental crowding with local causes) and also aesthetics of patients [1012]. The literature of
for the surgical-orthodontic treatment (orthodontic extrac- the field proposes numerous studies, analyzing
tion for mild and moderate crowdings) (p>0.05). The neces- this anomaly from various aspects, considering
sity and predictive factors of the treatment were adequate
with age, dentition, severity of crowding and Angle class
different populations, however the predictive
of malocclusion. factors of the dental crowding treatment are
Keywords: dental crowding, orthodontic treatment, neces- almost inexistent.
sity factors, predictors of treatment The present study starts from the hypothesis
that dental crowding is caused by certain specific
1. INTRODUCTION causal factors and that that their prompt removal
may prevent serious subsequent complications.
Dental crowding is characterized by the The objectives of the study were to trace the
negative difference between the necessary space characteristics of this anomaly in a population
and the existing space of the teeth on the dental from the North-East region of Romania, and to
arches, being possibly a symptom of skeletal evaluate the mean age of its detection, its clinical
malocclusions. The clinical forms of dental forms, its classes of diagnosis, the associated
crowding may be mild, moderate or severe, anomalies, the etiological causes, the need and
depending on their manifestation; in anterior, types of treatment to be recommended and the
intermediary, lateral or posterior position as a orthodontic appliances employed. The aim of the
function of location; primary, secondary, tertiary, study was to establish the necessity factors for
combined or transient, as a function of their solving dental crowding and the precision of the
etiology. Dental crowding may have general predictive factors for establishing possible
(crossed heredity or disendocrinopathies), treatment options.2.

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2. MATERIALS AND METHOD 3. RESULTS

The retrospective study was conducted on The patients considered for the study were
422 patients with ages between 6-24 years (mean divided into three age intervals, specific for the
age: 11.053.175 years), 165 (39.1%) boys with a development of dentition and of dental
mean age of 10.442.739 years and 257 (60.9%) occlusion: >9 years, 96 (22.7%) patients; between
girls with a mean age of 11.443.373 years. All 9-12 years, 199 (47.2%) patients; <12 years, 127
patients were from the North-East part of (30.1%) patients. 97 (23.0%) of them presented
Romania, 311 (73.7%) of them living in urban early mixed dentition, 154 (36.5%) late mixed
zones and 111 (26.3%) in rural areas. The dentition, 158 (37.4%) patients - permanent
criterion of patient selection was dental young dentition, and 13 (3.1%) patients -
crowding associated with the Angle classes of permanent complete dentition.
malocclusions. The subjects with genetic or According to the severity of dental crowding,
endocrine syndromes or with palatine clefts 118 (28%) cases of mild dental crowding, 228
were excluded. The orthodontic diagnosis was (54%) cased of moderate dental crowding and
established by clinical and complementary 76 (18%) cases of severe dental crowding were
exams (plaster cast, panoramic radiographs and registered, so that 286 (67.8%) cases were
lateral cephalometric radiography). All cases considered in Angle I malocclusion class, 112
received orthodontic treatment in the Clinic of (26.5%) cases in Angle II class and 24 (5.7%)
Orthodontics of the Sf. Spiridon Emergency cases, respectively, in Angle III class.
University Hospital of Iai, Romania, between Apart from dental crowding, the patients
1991 and 2010. After having obtained the presented other associated anomalies: crossbite
informed consent of either patients or of their - 247 (58.5) cases, deep bite - 184 (43.4%) cases,
parents, the study was conducted according to and mandibular lateral deviation - 150 (35.5%)
the Declaration of Helsinki issued in 1975, and cases.
revised in 2000. 95.3% of the dental crowdings had local
Statistical analysis was performed using the causes and 4.7% - general causes.
SPSS 16.0 package (SPSS Inc., Chicago, IL), 15.9% interceptive orthodontic and 93.1%
calculating the distributions of frequencies, the corrective (13.5% precocious, 38.6% normal and
descriptive statistical parameters and the 41.0% late) treatments have been applied. Space
Spearman correlation coefficient between the on the arches was obtained by maxillary
categories of variables. The correlation between expansion in 44.5% cases, by extractions of
the clinical signs and the therapeutical solutions permanent teeth - in 34.6% cases, and by serial
was established with the cross-tabulation extractions of temporary teeth - in 10.7% cases,
method, applying the chi-square (2) test. The on using removable biomechanical appliances
significant predictors were identified with a in 29.9% cases, fixed biomechanical appliances
model of binary logistic regression (B) and the in 27.5% cases and functional appliances,
validity of the model was determined with the respectively, in 1.8% cases.
Hosmer-Lemeshow goodness-of-fit test (HL Statistically significant correlations have been
test), at a significance level p>0.05. To eliminate found between dental crowding and the intervals
the multicollinearity problems, the multiple of age, type of dentition, Angle class of malocclusions,
correlations among factors was analyzed. etiological factors, types of treatments, modalities
Statistical analysis was conducted at a for creating space and types of orthodontic
significance level of 5% and p<0.05. appliances employed (table 1).

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Georgeta ZEGAN, Cristina Gena DASCLU, Radu Bogdan MAVRU, Daniela ANISTOROAEI

Table 1. Nonparametric correlations between dental crowding and variables

Dental crowding
Variables
Pearson rho p value
Gender 0.061 0.214
Environment 0.040 0.417
Age intervals 0.359** 0.000
Dentition types 0.379** 0.000
Angle class - 0.216* 0.000
Crossbite 0.076 0.241
Overbite 0.068 0.162
Mandibular deviation 0.043 0.383
Causes 0.566*** 0.000
Interceptive treatments 0.215* 0.000
Corrective treatments 0.357** 0.000
Surgical treatments 0.516*** 0.000
Extraction / expansion 0.129* 0.008
Appliance types 0.121* 0.013
*
weak correlation for rho<0.30;
**
average correlation for rho=0.30-0.50;
***
strong correlation for rho >0.50, significant correlations for p<0.05.

The interceptive treatment applied was Maxillary expansion was specific to ages
specific to the age >9 years (58.2%, 2=68.478, between 9-12 years (63.8%, 2=171.675, p=0.000),
p=0.000), to early mixed dentition (58.2%, to late mixed dentition (62.8%, 2=268.949,
2=75.875, p=0.000), severe dental crowding p=0.000), mild (54.3%) and moderate (44.7%,
(58.2%, 2=110.151, p=0.000) and also to the 2=128.368, p=0.000) dental crowding, to Angle I
Angle class I (68.7%, 2=16.546, p=0.001). (56.9%) and II (33.5%, 2=13.740, p=0.000) classes.
The corrective treatment was specific to The orthodontic extraction of permanent
ages between 9-12 years (49.6%, 2=63.993, teeth was specific to ages<12 years (67.1%,
p=0.000), to late mixed dentition (38.2%) and 2=171.675, p=0.000), to permanent dentition
to permanent dentition (43.2% 2=63.369, (93.8%, 2=268.949, p=0.000), to moderate
p=0.000), to moderate dental crowding (57.3%, (79.5%) and severe (20.5%, 2=128.368, p=0.000)
2=29.846, p=0.000) and to Angle class I (66.9%, dental crowding, to Angle I (74.0%) and II
2=47.035, p=0.000). (24.0%, 2=13.740, p=0.003) classes (table 2).

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Table 2. Necessity factors for dental crowding treatment

Cross-tabulations, Chi-square tests

n=422 Interceptive Corrective Maxillary Extractions
treatment treatment expansion teeth
n 39 72 62 0
>9 years
% 58.2 18.3 33.0 0.0
Age intervals

n 28 195 120 48
9-12 years
% 41.8 49.6 63.8 32.9
n 0 126 6 98
<12 years
% 0.0 32.1 3.2 67.1
2 68.478 63.993 171.675 171.675
p 0.000 0.000 0.000 0.000
n 39 73 62 1
Early mixed
% 58.2 18.6 33.0 0.7
Dentition types

n 28 150 118 8
Late mixed
% 41.8 38.2 62.8 5.5
n 0 170 8 137
Permanent
% 0.0 43.2 4.3 93.8
2
75.875 63.369 268.949 268.949
p 0.000 0.000 0.000 0.000
n 25 98 102 0
Mild
% 37.3 24.9 54.3 0.0
Dental crowding

n 3 225 84 116
Moderate
% 4.5 57.3 44.7 79.5
n 39 70 2 30
Severe
% 58.2 17.8 1.1 20.5
2 110.151 29.846 128.368 128.368
p 0.000 0.000 0.000 0.000
n 46 263 107 108
Class I
% 68.7 66.9 56.9 74.0
n 12 108 63 35
Angle Class

Class II
% 17.9 27.5 33.5 24.0
Class III n 9 22 18 3
% 13.4 5.6 9.6 2.0
2 16.546 47.035 13.740 13.740
p 0.001 0.000 0.000 0.003

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Georgeta ZEGAN, Cristina Gena DASCLU, Radu Bogdan MAVRU, Daniela ANISTOROAEI

The model of binary logistic regression treatment (local factors, maxillary expansion and
permitted identification of the significant orthodontic extraction) with a precision of
predictive factors for the interceptive orthodontic 95.3% (test HL, p=0.618); for the surgical-
treatment (mild and moderate crowding and orthodontic treatment (mild and moderate
maxillary expansion), with a precision of 92.4% crowding and orthodontic extraction), with a
(test HL, p=0.410); for the corrective orthodontic precision of 91.5% (test HL, p=0.306) (table 3).

Tabel 3 Binary logistic regression analysis of predictive factors

95% Confidence
Wald p interval for OR
Parameters B OR
statistic value
Lower Upper
Interceptive orthodontic treatment
Mild crowding -1.366 18.052 0.000 0.255 0.136 0.479
Moderate crowding -4.370 48.913 0.000 0.013 0.004 0.043
Maxillary expansion 2.643 23.438 0.000 14.060 4.822 40.995
Corrective orthodontic treatment
Local causes -2.125 10.504 0.001 0.119 0.033 0.432
Maxillary expansion -1.053 5.070 0.024 0.349 0.140 0.873
Orthodontic extraction -3.702 16.842 0.000 0.025 0.004 0.145
Surgical-orthodontic treatment
Mild crowding -2.699 11.668 0.001 0.067 0.014 0.317
Moderate crowding -1.036 4.073 0.044 0.355 0.130 0.971
Orthodontic extraction -5.112 152.738 0.000 0.006 0.003 0.014

4. DISCUSSION patients, detection of dental crowding occurred

during late mixed dentition and the permanent
The present research was performed on a young one, for both sexes. If identified in early
group of patients suffering from various clinical mixed dentition, dental crowding may be solved
forms of dental crowding, treated orthodontically, by means of conservative techniques and with
by evaluating their age intervals and type of minimum dental costs [13,14]; however, when
dentition in the moment of its detection, the identified in adolescent patients, the type of
Angle classes of diagnosis, the associated intervention is different and more complex, both
anomalies, the etiological causes and types of orthodontically and surgically [15,16]. Most of
therapeutical needs, in order to find the the cases were represented by moderate dental
statistically significant necessity and predictive crowding, included in Angle I malocclusion
factors of the treatment. class, associated with crossbite, induced by local
For avoiding any possible statistical error, causes.
patients with the same characteristics have been The chi-square test identified the necessity
selected. The multiple variables resulting from factors for the interceptive orthodontic (age >9
the characteristics of the experimental group years, early mixed dentition, severe dental
were employed in the study. The effects under crowding from Angle I class) and corrective
investigation were based on the statistically treatment (age between 9-12 years, late mixed
significant relations established with the age, dentition, permanent dentition, moderate dental
dentition, cause, effect and therapy applied to crowding from Angle I class) and for maxillary
patients. Considering the mean age of the expansion (age between 9-12 years, late mixed

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 NECESSITY FACTORS AND PREDICTORS OF DENTAL CROWDING TREATMENT

dentition, mild and moderate dental crowding of Iassy, receiving funds from the European
from Angle I and II classes) and extraction of Social Fund through the Sectoral Operational
permanent teeth for orthodontic reasons (age Programme Human Resources Development
<12 years, permanent dentition, moderate and 2007-2013.
severe dental crowding from Angle I and II
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