ORIGINAL ARTICLE

Analysis of dental and basal bone arch

form correlations in skeletal Class II
malocclusion
Kaiyu Fu,a Shu Fang,b Xiangfei Fan,c Chunli Liu,c Chunxiang Zhang,c Jing Liu,d and Danna Xiaoc,e
Tianjin, Beijing, and Hebei, China

Introduction: This study aimed to establish mathematical equations to describe the dental and basal arch forms
in skeletal Class II malocclusion and to investigate correlations between these forms to facilitate clinical diag-
nosis and treatment design. Methods: Cone-beam computed tomography images of 60 patients (30 each
with skeletal Class II malocclusion and normal occlusion) were subjected to 3-dimensional volume rendering,
image reconstruction, and measurement. Using a computer program written in Java on the Eclipse platform
(Eclipse Foundation, Ottawa, Canada), a beta function was used to establish mathematical models of dental
and basal bone arch forms, and model-fitting was performed. Results: A mathematical model was developed
to describe the dental and basal arch forms in skeletal Class II malocclusion. The maxillary and mandibular
dental arch lengths were significantly longer in skeletal Class II malocclusion than in normal occlusion, whereas
the width of the maxillary molar segment was smaller. The maxillary molar and mandibular intercranial segments
in the basal arch were significantly longer in skeletal Class II malocclusion than in normal occlusion, whereas the
mandibular intercranial segment width was smaller. Conclusions: The dental arch and basal bone arch forms in
the maxilla and mandible follow individual curves, described by a beta function. In skeletal Class II malocclusion,
the dental and basal arches are discrepant in horizontal and anteroposterior dimensions, which should be
considered during orthodontic treatment planning to improve arch matching. (Am J Orthod Dentofacial Orthop
2021;159:202-9)

T
he relationship between dental and basal forms However, previous studies that investigated basal form
have significant effects on orthodontic diagnosis dimensions using different definitions have yielded con-
and treatment planning. If teeth are moved exces- flicting results. Moreover, previous studies that investi-
sively, over the limits of their supporting basal bone, gated the relationship of the basal bone and dental
periodontal complications and relapse may occur.1 arches did not investigate both jaws concurrently;
thus, this relationship between the maxillary and
a
mandibular arches.
Department of Pediatric Dentistry, Tianjin Stomatological Hospital, School of
Medicine, Nankai University, Tianjin, China. In 1925, Lundstr€ om2 proposed the term “apical base”
b
Department of Stomatology, Aviation General Hospital, China Medical Univer- to refer to the junction of the alveolar and basal bones of
sity, Beijing, China. the maxilla and mandible near the apices of the teeth. In
c
Department of Orthodontics, Tianjin Stomatological Hospital, School of Medi-
cine, Nankai University, Tianjin, China. early studies,3,4 based on casts and lateral cephalometric
d
Department of Orthodontics, Stomatology Hospital of Cangzhou, Hebei, China. radiographs, investigators described the lowest point of
e
Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tian- the anterior alveolar border in the maxilla and mandible
jin Stomatological Hospital, Nankai University, Tianjin, China.
Kaiyu Fu and Shu Fang are joint first authors and contributed equally to this as the basal bone. Later, different points of the alveolar
work. bone were used in various studies to determine the basal
All authors have completed and submitted the ICMJE Form for Disclosure of bone.5-7 The Bonwill-Hawley arch form, which is based
Potential Conflicts of Interest, and none were reported.
This study was supported by grants from the National Key Clinical Specialist Con- on the principle of individualized arches, was the first
struction Programs of China (Orthodontics) ([2013] No. 544) and the Key Subject selected for mathematical modeling.8,9 Later, various
of Tianjin Healthcare Industry (No. 16KG148). mathematical functions10-12 were applied to dental
Address correspondence to: Danna Xiao, Department of Orthodontics, Tianjin
Stomatological Hospital, School of Medicine, Nankai University, 75 Dagu Rd, arch curve fitting. Braun et al13 considered that the
Heping District, Tianjin 300041, China; e-mail, [email protected]. beta function provided the closest fit to the curve of
Submitted, June 2019; revised, November 2019; accepted, December 2019. the human dental arch, with correlation coefficients of
0889-5406/$36.00
Ó 2020 by the American Association of Orthodontists. All rights reserved. curve fit exceeding 0.98 for all types of arch forms.
https://doi.org/10.1016/j.ajodo.2019.12.026 Mina et al14 also proved that the beta function provided
202
Fu et al 203

a higher degree of fit for dental or basal arch forms in

Table I. Demographic information of the 60 subjects
normal occlusion. In our study, we used a novel least
in this study
squares method to describe the basal bone arch on
cone-beam computed tomography (CBCT) images and Variables GII group GN group
evaluate the transverse dimensions of skeletal Class Patients, n 30 30
malocclusion, without interference by the variable over- Mean age, y, mean 6 SD 21.47 6 2.75 20.83 6 2.54
Female 21.78 6 2.91 20.23 6 2.51
lying soft tissues.15
Male 20.90 6 2.35 21.61 6 2.37
Several studies have focused on characterizing the
SD, Standard deviation.
dental arch or basal bone arch forms of patients with
Class II malocclusion.7,16-18 Patients with Class II
Division I malocclusion are considered to have a difference between the 2 groups (P 5 0.792). The demo-
narrower maxillary dental arch than those with Class I graphic information is shown in Table I.
occlusion. However, the mandibular characteristics of The inclusion criteria were as follows: (1) full perma-
the dental and basal arch forms were not consistent nent dentition (excluding third molars); (2) minor length
across studies. Ball et al17 and Gupta et al18 stated discrepancy for each arch (crowding #3 mm,
that there was no significant difference in the dental spacing #3 mm); (3) for GII group, bilateral Class II
and basal arch forms between subjects with Class II Di- canine and molar relationships and protrusive incisors
vision 1 malocclusion and those with Class I ideal occlu- with ANB $5
; and (4) for the GN group, bilateral Class
sion. Sayin et al19 and Uysal et al20 argued that the I canine and molar relationships and a normal overbite
mandibular intercanine width was greater in Class II Di- and overjet with 0
# ANB # 4
.
vision 1 arches than in normal occlusions. Exclusion criteria were as follows: (1) dentition with
In contrast, Al-Hilal7 determined that the mandibular decayed or cracked teeth; (2) dentition with a prosthetic
dental and basal arch widths of patients with Class II Di- crown or restoration-altered tooth size and clinical
vision 1 malocclusion were smaller than those of pa- crown form; (3) unilateral or bilateral crossbite; (4) a his-
tients with Class I occlusion. In general, most studies tory of orthodontic treatment; and (5) a history of
only focused on evaluating the transverse dimensions trauma or oral and maxillofacial surgery.
of arch forms or describing the dental and basal forms All CBCT images were acquired using a KaVo 3D
of the maxilla or the mandible. Seldom previous studies eXam device (Imaging Sciences International, Hatfield,
paid attention to the incoordination between maxillary Pa) (120 kVp; 3-7 mA; 0.40-mm voxel size; scan time,
and mandibular arch forms, particularly at the basal 26.9 seconds; and field of view of 242 3 193 mm).
bone arch level. CBCT data were exported in digital imaging, and imag-
Thus, the objectives of this study were as follows: (1) ing information was imported into the Invivo software
to establish mathematical equations to describe the (version 5.4; Anatomage, San Jose, Calif) for 3-
dental and basal arch forms in skeletal Class II malocclu- dimensional (3D) volume rendering, image reconstruc-
sion by computer programming and (2) to compare the tion, and measurement and recording of coordinate
matching between the dental and basal bone arch forms, values. Then, the 3D coordinates were transformed
which could facilitate clinical diagnosis, thereby into 2-dimensional coordinates by performing mathe-
revealing disharmonious relationships and ensuring the matical operations of the work plane. We improved the
formulation of individualized treatment plans. calculation process and completed software develop-
ment with regard to data processing and acquirement.
Operational programs were written in Java on the Eclipse
MATERIAL AND METHODS development platform (Eclipse Foundation, Ottawa,
This study was approved by the ethics committee of Canada).
the Tianjin Stomatological Hospital, Tianjin, China. For dental measurements, the fa point is defined as
CBCT records of patients who visited the Tianjin Stoma- the midpoint of the facial axis of the clinical crown.
tological Hospital between September 2014 and January The fa points from the right second molar to the left
2017 were studied. The need to obtain informed patient second molar in the maxilla and mandible were recorded
consent was waived as all data were anonymized. The (n 5 28). Four quadrants of teeth (from the upper right)
study population comprised 60 subjects aged between were marked in order as A, B, C, and D. The specific land-
18 and 28 years (male: 18-26 years, female: 18-28 years), marks of teeth in the 4 quadrants were displayed in
including 30 skeletal Class II (GII group; 11 men and 19 Figure 1.
women) and 30 skeletal Class I (GN group; 13 men and The 3D intracranial reference planes were oriented
17 women) malocclusions. There was no sex-specific according to the following 4 reference planes. The

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204 Fu et al

(right: Afa-70 , coordinate [W7/2, 0]; left: Bfa-70 , coor-

dinate [W7/2, 0]); the midpoint of the connecting line
was recorded as the origin O point (0, 0) (Fig 4). The ver-
tical axis (y-axis) was perpendicular to the x-axis and
passed through the origin. The projection of the con-
necting point of the maxillary central incisors was re-
corded as point O’ (0, D7). The conversion of the
projection points is shown in Table II.
The relationships between dental arch width and
depth can be described by the beta function, which is
simplified as follows: Y 5 D [1  (2x/W)2]e. Compared
with other mathematical functions, the beta function
represents the dental arch form the closest.23 D is the
Fig 1. The fa points from the right second molar to the left vertical distance from the point adjacent to the left
second molar in the maxilla and mandible were marked and right central incisors to the second permanent molar
in order as A, B, C, and D (take canines and the
line. W represents the horizontal distance between the
second molar, for example). AB-fa-0 is the proximal con-
tact point of maxillary middle incisors.
second permanent molars on both sides. The constant
value e is affected by all teeth or basal bone positions,
especially by the relative position of the canine, which
occlusion plane (O-plane) was an optimization plane determines the curve shape of the dental or basal arch.
calculated using the Artificial Bee Colony (ABC) algo- To obtain the best-fitting curve for each group, we
rithm21 by analyzing 28 markers of maxillary and applied the ABC algorithm to acquire the optimal coor-
mandibular teeth using the programming software. dinates of each tooth position in the dental and basal
The algorithm is used for solving multimodal optimiza- arches. The e value was acquired by finding the optimal
tion problems and simplifies the calculation.22 The curve that could fit multiple positions using our program
maxillary basal bone (A-plane) was parallel to the O- based on the algorithm.
plane, which passed through the A point. The mandib-
ular basal planes (B-plane) was parallel to the O-plane, Statistical analysis
which passed through the B point. The midsagittal plane
A fitting analysis of all markers was carried out be-
was defined by the Nasion, Anterior nasal spine, and Ba-
tween the beta function and arch form curve with
sion points. The reference planes are shown in Figure 2.
SPSS software (version 17.0; SPSS Inc, Chicago, Ill).
The anatomic apical point (Ap) of all 28 teeth were
The width and length differences between the basal
recorded. For premolars and molars, the position of
bone and dental arch in the maxilla and mandible
the Ap was calculated with the following formula:
were recorded (Table III). Intercanine and intermolar
([X0, Y0, Z0] 5 [X1 1 X2 1.1 Xn]/
lengths and widths in the GII and GN groups were
n 1 [Y1 1 Y2 1.1Yn]/n 1 [Z1 1 Z2 1.1 Zn]/n
compared using 2 independent sample t tests. Correla-
[n $ 2]). The T-plane was parallel to the A-plane and
tion statistics were used to assess the correlation be-
passed through the Ap point. The H-plane was perpen-
tween the fa and ba projection point distances for
dicular to the A-plane and parallel to the midsagittal
both groups.
plane. The T- and H-plane intersected at a line referred
to as the line T. The landmarks of the basal bone (ba
point) were intersections of line T and the anterior RESULTS
border of the basal bone. The basal bone points in the The distances between fa0 and ba0 points for each
mandible were defined similarly by referring to the B- tooth in skeletal Class II malocclusion are shown in
plane. All basal bone makers are displayed in Figure 3. Table IV. These values were positive in both the maxilla
The 2-dimensional coordinate values were pro- and the mandible. The curvatures of the projection
grammed by the projection of the 3D coordinate values points for the dental arch and basal form are compared
on the occlusion plane (standard work plane). Projec- in Figure 5; the fa0 points were located buccally relative
tions of fa and ba were marked as fa0 and ba0 . The origin to the corresponding ba0 points. The curve fitting anal-
(0, 0) of the coordinate system, and 2 axes (x, y) were ysis is provided in Supplementary Tables I and II.
constructed. For the convenience of calculations, the Descriptive statistics for dental and basal bone widths
transverse axis (x-axis) was set as the line connecting and lengths for the GII and GN groups are displayed in
the projection points of the maxillary second molars Table V. Compared with the GN group, the width of

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Fu et al 205

Fig 2. O-plane, an optimization plane was calculated using the ABC algorithm by analyzing 28 markers
of maxillary and mandibular teeth using programming software. A-plane (A subspinale plane), A-plane
was parallel to the O-plane, passing through the A point; B-plane (B supramental plane), A-plane was
parallel to the O-plane, passing through the B point; midsagittal plane, A-plane constructed with N,
which is perpendicular to the line connecting bilateral frontozygomatic point.

Fig 3. Determining of basal bone makers (take maxillary right middle incisor, for example). T-plane
(apical point plane), the T-plane intersected with the midsagittal plane on line T, passing through the
Ap point.

the maxillary posterior molars in skeletal Class II maloc- The differences in the widths and lengths in the
clusion was significantly smaller. No significant differ- dental and basal arches between the occlusion groups
ences were found between the malocclusion and the were compared (Table VI). The difference value was
normal occlusion groups in the mandibular arch. More- larger in the GII group than in the GN group, in both
over, Table VI shows that the lengths of the maxillary maxillary and mandibular arch forms.
and mandibular arch forms of the GII group were signif- The differences in the widths and lengths between
icantly longer than in the GN group. the dental and basal arches in the 2 groups were also
For basal bone comparisons, the length in the maxil- compared (Table VII). The differences between the GII
lary second molar sites in the GII group was slightly and GN groups were not statistically significant.
larger than in the GN group. The width in the GII group E values of the dental and basal bone arches in the
was smaller than in the GN group. In contrast, for occlusion groups are shown in Table VIII. The fitting
mandibular canine sites, the length was larger (Table curves indicate that the anterior segments in the maxil-
VII). The final curve fitting of Class II malocclusion lary and mandibular dental arches were narrower and
were displayed in Supplementary Fig. longer in the GII group than in the GN group. Moreover,

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206 Fu et al

Table III. The width and length differences between

the basal bone and dental arch in the maxilla and
mandible
Abbreviation Definition
AB-Wfb-3 The difference in width between the basal bone and
dental arch projections at the maxillary canines.
AB-Wfb-7 The difference in width between the basal bone and
dental arch projections at the maxillary
second molars.
CD-Wfb-3 The difference in width between the basal bone and
dental arch projections at the mandibular canine.
CD-Wfb-7 The difference in width between the basal bone and
dental arch projections at the mandibular
second molars.
AB-Lfb-3 The difference in length between the basal bone and
dental arch projections at the maxillary canine.
AB-Lfb-7 The difference in length between the basal bone and
dental arch projections at the maxillary
second molars.
Fig 4. The 2-dimensional coordinate values were con- CD-Lfb-3 The difference in length between the basal bone and
structed by the projection of the 3D coordinate values dental arch projections at the mandibular canine.
on the occlusion plane. The origin (0, 0) was set as the CD-Lfb-7 The difference in length between the basal bone and
midpoint of the line connecting the projection points of dental arch projections at the mandibular
second molars.
the maxillary second molars (Bfa-70 [W7/2, 0] and Afa-70
W-fa-3 The difference in width between the maxillary and
[W7/2, 0]). The transverse axis (x-axis) was set as the mandibular canine projections in the dental arch.
line connecting the projection points of the maxillary W-fa-7 The difference in width between the maxillary and
second molars (right: Afa-70 , coordinate [W7/2, 0]; left: mandibular second molars projections in the dental
Bfa-70 , coordinate [W7/2, 0]). The midpoint of the connect- arch.
ing line was recorded as the origin O point (0, 0) (Fig 4). W-ba-3 The difference in width between the maxillary and
The vertical axis (y-axis) was perpendicular to the x-axis mandibular canine projections in the basal bone
and passed through the origin. The projection of the con- arch.
necting point of the maxillary central incisors was re- W-ba-7 The difference in width between the maxillary and
corded as point O’ (0, D7). mandibular second molars projections in the basal
bone arch.
L-fa-3 The difference in length between the maxillary and
Table II. Landmarks and definitions of arch- mandibular canine projections in the dental arch.
dimension variables in 2-dimensional (2D) coordinate L-fa-7 The difference in length between the maxillary and
mandibular second molars projections in the dental
Landmarks Definitions arch.
Dental arch landmarks in 2D L-ba-3 The difference in length between the maxillary and
coordinate (fa0 point) mandibular canine projections in the basal bone
Right upper quadrant Afa-110 , Afa-120 , Afa-130 , Afa-140 , arch.
Afa-150 , Afa-160 , Afa-170 L-ba-7 The difference in length between the maxillary and
Left upper quadrant Bfa-210 , Bfa-220 , Bfa-230 , Bfa-240 , mandibular second molars projections in the basal
Bfa-250 , Bfa-260 , Bfa-270 bone arch.
Right lower quadrant Cfa-410 , Cfa-420 , Cfa-430 , Cfa-440 ,
Cfa-450 , Cfa-460 , Cfa-470
Left lower quadrant Dfa-310 , Dfa-320 , Dfa-330 , Dfa-340 , the curves appeared conoid. For the basal bone form, the
Dfa-350 , Dfa-360 , Dfa-370 GII group had a wider anterior segment in the maxillary
Basal bone arch landmarks in arch and a narrower anterior segment in the mandibular
2D coordinate (ba0 point) arch.
Right upper quadrant Aba-110 , Aba-120 , Aba-130 , Aba-
140 , Aba-150 , Aba-160 , Aba-170
Left upper quadrant Bba-210 , Bba-220 , Bba-230 , Bba- DISCUSSION
240 , Bba-250 , Bba-260 , Bba-270 Our study used a beta function to describe anatomic
Right lower quadrant Cba-410 , Cba-42a0 , Cba-43a0 ,
Cba-44a0 , Cba-45a0 , Cba-46a0 ,
points to obtain the optimal arch form in Class II maloc-
Cba-47a0 clusion. Compared with other mathematical models,
Left lower quadrant Dba-310 , Dba-320 , Dba-330 , Dba- such as the catenary curve, elliptical curve, and conic
340 , Dba-350 , Dba-360 , Dba-370 section, the beta function has the highest fit, with

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Fu et al 207

Table IV. The distances between the fa0 and ba0

projection points for each tooth in skeletal Class II
malocclusion
Correlation
Projection Relative coefficient Regression
points value (r) equation
Maxilla
A7 fa0 -ba0 1.75 0.747 y 5 0.513x 1 0.725
A6 fa0 -ba0 1.54 0.905 y 5 0.829x 1 1.339
A5 fa0 -ba0 2.09 0.829 y 5 0.818x 1 4.538
A4 fa0 -ba0 2.93 0.704 y 5 0.822x 1 1.078
A3 fa0 -ba0 7.19 0.917 y 5 0.624x 1 3.828
A2 fa0 -ba0 9.56 0.773 y 5 0.479x 1 9.037
A1 fa0 -ba0 11.59 0.870 y 5 0.562x 1 6.051
B1 fa0 -ba0 11.62 0.742 y 5 0.574x 1 5.567
B2 fa0 -ba0 9.93 0.842 y 5 0.642x 1 3.008
B3 fa0 -ba0 7.33 0.916 y 5 0.564x 1 5.499 Fig 5. Dental and basal bone arch form curves of skel-
B4 fa0 -ba0 4.30 0.897 y 5 0.589x 1 4.962 eton Class II malocclusion by fitting beta function.
B5 fa0 -ba0 2.35 0.760 y 5 0.485x 1 7.186
B6 fa0 -ba0 2.71 0.837 y 5 0.425x 1 6.537
B7 fa0 -ba0 3.76 0.746 y 5 0.719x 1 4.395 employing the ABC algorithm and programming in our
Mandible study to calculate the e value and find the best-fitting
C7 fa0 -ba0 7.62 0.697 y 5 0.324x 1 9.808 curve in each group. Thus, we computed the e value after
C6 fa0 -ba0 4.43 0.730 y 5 0.247x 1 12.11 fitting 8-10 landmarks of each arch form. This method
C5 fa0 -ba0 1.40 0.881 y 5 0.555x 1 8.091
C4 fa0 -ba0 3.00 0.906 y 5 0.624x 1 6.237
simplified the clinical calculation of the data as it used
C3 fa0 -ba0 4.92 0.726 y 5 0.618x 1 6.850 an intelligence algorithm. It also made the results of
C2 fa0 -ba0 6.04 0.882 y 5 0.755x 1 2.579 our study more concordant with the actual form shape.
C1 fa0 -ba0 6.41 0.847 y 5 0.703x 1 4.617 These results can be made more accurate by expanding
D1 fa0 -ba0 6.41 0.817 y 5 0.771x 1 2.092 the sample size in future research.
D2 fa0 -ba0 5.96 0.914 y 5 0.746x 1 2.983
D3 fa0 -ba0 5.02 0.763 y 5 0.599x 1 7.320
The e values in the beta function, which especially
D4 fa0 -ba0 2.95 0.786 y 5 0.619x 1 6.461 reflect the characteristics of the anterior segment of the
D5 fa0 -ba0 1.69 0.785 y 5 0.431x 1 10.356 dental or base bone arches, were calculated. We deter-
D6 fa0 -ba0 4.58 0.759 y 5 0.273x 1 10.766 mined that the larger the e value in the beta function,
D7 fa0 -ba0 7.44 0.883 y 5 0.502x 1 8.938 the longer and narrower was the curve that fit the arch
forms.
correlation coefficients over 0.98, for representing the The e value of the maxillary dental arch curve (0.730)
morphologic characteristics of the arch curvature.13,14 was higher than that of the maxillary basal bone arch curve
Our results were in accordance with Noroozi's24 theory (0.721) in patients with skeletal Class II malocclusion, sug-
that the overall form of the dental arch is affected by gesting that the maxillary anterior dental arch was nar-
the depth of the canine, the width of the canine, the rower than its corresponding basal bone arch. The e
depth of the molar, and the width of the molar. value of the mandibular dental arch curve (0.717) was
The constant value e describes the morphologic char- smaller than that of the mandibular basal bone arch curve
acteristics of the anterior segment of the dental arch and (1.243), suggesting that the arch width of the anterior
the basal bone arch. Braun et al13 first used the beta segment of the mandibular dental arch was wider than
function for dental arched fitting in Class I, Class II, its basal bone arch. In other words, the basal arch was
and Class III malocclusions. However, their study only significantly larger than the dental arch in the maxilla
considered the molar depth and intermolar width as pa- but smaller in the mandible. Ball et al17 found that the dis-
rameters in beta function, both of which may be influ- tance between dental and basal bone points was highly
enced by intercanine width and canine depth. A correlated in the canine and molar area in the mandibles
previous study25 used a convenient method based on of subjects with Class II Division I malocclusion, with cor-
data of the canine area to obtain the e value, but this relation coefficients of 0.84 and 0.85, respectively. This
approach reduced the accuracy of curve fitting, as the finding was consistent with the results of our study.
method was affected by crowding and methodic error. In previous studies on the morphology of the dental
To minimize error and reduce the manual calculation and basal bone arches in patients with skeletal Class II
workload in our study, we improved the method by malocclusion, the morphologic characteristics of the

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208 Fu et al

Table V. Comparison of dental and basal bone widths Table VIII. E values of curve fitting in GN group and
and lengths for the GII and GN groups GII group
Projection points GN group, mm GII group, mm P value Variables GN group GII group
AB-Wf-3 37.54 6 2.34 36.98 6 1.45 0.268 Maxillary dental arch 0.690 0.730
AB-Wf-7 63.38 6 3.68 61.48 6 2.68 0.026* Mandibular dental arch 0.662 0.717
CD-Wf-3 29.33 6 1.81 28.89 6 1.43 0.292 Maxillary basal bone arch 0.756 0.721
CD-Wf-7 61.54 6 3.47 59.94 6 3.56 0.083 Mandibular basal bone arch 1.207 1.243
AB-Lf-3 7.26 6 1.47 9.21 6 0.91 0.000**
AB-Lf-7 37.75 6 2.89 40.58 6 0.38 0.000** there are some disputes7,19 about the morphologic char-
CD-Lf-3 3.93 6 0.93 5.38 6 0.75 0.000** acteristics of the mandibular arch and basal bone arch in
CD-Lf-7 34.80 6 2.44 37.04 6 1.28 0.000** Class II Division I malocclusion.7,19 We performed a
AB-Wb-3 32.35 6 2.64 31.92 6 1.89 0.472
comprehensive comparative analysis of dental and basal
AB-Wb-7 65.19 6 3.11 65.96 6 2.70 0.312
CD-Wb-3 25.88 6 2.39 24.22 6 2.04 0.005** bone arches in both the maxilla and the mandible. We
CD-Wb-7 77.72 6 4.01 78.42 6 4.49 0.522 found that, in the dental arch comparison, the widths
AB-Lb-3 5.39 6 0.96 5.45 6 1.19 0.849 of the anterior segment in both the maxilla and
AB-Lb-7 27.97 6 2.65 29.15 6 1.72 0.047* mandible were narrower in Class II malocclusion than
CD-Lb-3 4.23 6 1.02 4.91 6 0.79 0.005**
in normal occlusion. In comparing the basal bone arch,
CD-Lb-7 30.95 6 2.72 30.90 6 1.88 0.941
the anterior segment in the maxilla was wider, whereas
*P \0.05; **P \0.01.
it was smaller and deeper in the mandible in Class II
malocclusion than in normal occlusion.
For skeletal Class II malocclusion, the dental arch was
Table VI. Comparison of the differences in the widths narrower than its corresponding basal bone arch in the
and lengths in the dental and basal arches in 2 groups maxillary canine segment but wider in the mandibular
Projection points GN group, mm GII group, mm P value canine segment. This finding may be due to teeth
AB-Wfb-3 5.20 6 2.43 5.06 6 2.16 0.825 compensating for mandibular deficiency. Moreover,
AB-Wfb-7 1.81 6 2.20 4.47 6 2.54 0.000** the intercanine width of the maxilla was narrower than
CD-Wfb-3 3.45 6 2.56 4.66 6 1.75 0.038* that of the mandible, suggesting retraction of the
CD-Wfb-7 16.17 6 4.55 18.48 6 4.29 0.048*
mandible may occur as a compensation for the mismatch
AB-Lfb-3 1.86 6 1.59 3.76 6 1.39 0.000**
AB-Lfb-7 9.78 6 2.54 11.43 6 1.74 0.005** in the width of the canine segment in the maxillary and
CD-Lfb-3 0.29 6 1.13 0.46 6 1.01 0.012* mandibular arches.
CD-Lfb-7 3.86 6 2.20 6.14 6 1.35 0.000** Our results also showed that, in skeletal Class II
*P \0.05; **P \0.01. malocclusion, the forms of the maxillary and mandibular
dental arches and of the maxillary basal bone arch were
oval, whereas the form of the mandibular basal bone
Table VII. Comparisons of differences between the arch was tapered. In comparison, in normal occlusion,
dental and basal arches in the maxilla and mandible both the dental and basal arches were narrower, partic-
in 2 groups ularly in the mandibular basal bone. In addition, as
shown in Figure 5, the lengths of the maxillary and
Projection points GN group, mm GII group, mm P value mandibular dental arches were significantly longer
W-fa-3 8.21 6 1.50 8.10 6 1.34 0.759
than the corresponding basal bone arches in Class II
W-fa-7 1.83 6 2.83 1.54 6 3.01 0.704
W-ba-3 6.47 6 2.12 7.69 6 2.69 0.059 malocclusion, suggesting that there is a marked
W-ba-7 12.52 6 4.09 12.46 6 4.72 0.959 mismatch in the length and width between the maxillary
L-fa-3 3.32 6 1.13 3.83 6 0.76 0.051 and mandibular dental arches and the basal bone arches.
L-fa-7 2.95 6 1.60 3.53 6 1.32 0.136 There was a significant disharmony between the number
L-ba-3 1.16 6 1.50 0.53 6 1.23 0.086
of teeth and the bone quantity in skeletal Class II maloc-
L-ba-7 2.98 6 3.01 1.76 6 2.57 0.103
clusion. These results suggest that clinicians should be
maxillary dental arch were relatively consistent.12,16,19,26 cautious in designing schemes for arch expansion in
Thus, compared with subjects with Class I occlusion, the the clinical treatment of skeletal Class II malocclusion
width of the dental arch was smaller, and the length was to avoid breaking the physical boundaries between the
longer in patients with Class II malocclusion. This dental arch and the basal bone. In the process of ortho-
finding was consistent with the fact that the arch width dontic treatment, reducing the diameter to achieve a
of the maxillary anterior segment was smaller than balance between the number of teeth and the bone
that seen in normal occlusion in our study. However, quantity may be a more advantageous option.

February 2021  Vol 159  Issue 2 American Journal of Orthodontics and Dentofacial Orthopedics
Fu et al 209

CONCLUSIONS and Class II Division 1 adult Syrian patients using cone-beam

computed tomography. J Contemp Dent Pract 2018;19:431-7.
The dental and basal arch forms in skeletal Class II 8. Germane N, Staggers JA, Rubenstein L, Revere JT. Arch length con-
malocclusion were individualized. The beta function siderations due to the curve of Spee: a mathematical model. Am J
was reliable methods for dental and basal arch curve Orthod Dentofacial Orthop 1992;102:251-5.
fitting. Compared with the normal occlusion group, 9. White LW. Individualized ideal arches. J Clin Orthod 1978;12:
779-87.
the dental arch lengths in skeletal Class II malocclusion
10. Currier JH. A computerized geometric analysis of human dental
were longer in both the maxilla and mandible, indicating arch form. Am J Orthod 1969;56:164-79.
that dental arch forms were tapered. In the basal bone 11. Jones ML, Richmond S. An assessment of the fit of a parabolic
comparison, the arch width was smaller in the maxilla curve to pre- and post-treatment dental arches. Br J Orthod
and was larger in the mandible in skeletal Class II maloc- 1989;16:85-93.
12. Sampson PD. Dental arch shape: a statistical analysis using conic
clusion than in normal occlusion. Moreover, the differ-
sections. Am J Orthod 1981;79:535-48.
ences in the widths and lengths in the dental and basal 13. Braun S, Hnat WP, Fender DE, Legan HL. The form of the human
arches were larger than the normal occlusion group, dental arch. Angle Orthod 1998;68:29-36.
suggesting that horizontal and anteroposterior dimen- 14. Mina M, Borzabadi-Farahani A, Tehranchi A, Nouri M,
sions of dental and basal arches are not coordinated. It Younessian F. Mathematical beta function formulation for maxil-
lary arch form prediction in normal occlusion population. Odon-
is more appropriate for clinicians to make individualized
tology 2017;105:229-36.
archwires to improve matching between the maxillary 15. Menezes CC, Janson G, da Silveira Massaro C, Cambiaghi L,
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level measurements of CBCT cross sections using different resolu-
ACKNOWLEDGMENTS tions. Angle Orthod 2016;86:535-42.
16. Nie Q, Lin J. A comparison of dental arch forms between Class II
The authors thank Peng Lu for computer technology Division 1 and normal occlusion assessed by Euclidean distance
support. matrix analysis. Am J Orthod Dentofacial Orthop 2006;129:
528-35.
SUPPLEMENTARY DATA 17. Ball RL, Miner RM, Will LA, Arai K. Comparison of dental and apical
base arch forms in Class II Division 1 and Class I malocclusions. Am
Supplementary data associated with this article can J Orthod Dentofacial Orthop 2010;138:41-50.
be found, in the online version, at https://doi.org/10. 18. Gupta D, Miner RM, Arai K, Will LA. Comparison of the mandibular
1016/j.ajodo.2019.12.026. dental and basal arch forms in adults and children with Class I and
Class II malocclusions. Am J Orthod Dentofacial Orthop 2010;138:
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American Journal of Orthodontics and Dentofacial Orthopedics February 2021  Vol 159  Issue 2
209.e1 Fu et al

Supplementary Fig. The final curve fitting of Class II malocclusion. A, The maxillary dental arch
curve fitting equation was as follows: y 5 41.01[1  (2x/61.08)2]0.73; B, the mandibular dental arch
curve fitting equation was as follows: y 5 37.35[1  (2x/59.55)2]0.717; C, the maxillary basal bone
arch curve fitting equation was as follows: y 5 29.15[1  (2x/65.63)2]0.721; D, the mandibular basal
bone arch curve fitting equation was as follows: y 5 30.91[1  (2x/79.19)2]1.242.

February 2021  Vol 159  Issue 2 American Journal of Orthodontics and Dentofacial Orthopedics
Fu et al 209.e2

Supplementary Table I. The curve fitting analysis of Supplementary Table II. The curve fitting analysis of
fa0 points and beta function ba0 points and beta function
Dental arch Relative Correlation Dental arch Relative Correlation
points value coefficient (r) Regression equation points value coefficient (r) Regression equation
Maxilla Maxilla
AFa-110 0.08 0.969 y 5 0.945x 1 2.220 Aba-110 0.57 0.962 y 5 0.885x 1 2.962
Afa-120 0.46 0.773 y 5 0.789x 1 7.831 Aba-120 1.05 0.760 y 5 0.843x 1 4.754
Afa-140 0.69 0.872 y 5 0.867x 1 3.375 Aba-140 1.11 0.751 y 5 0.592x 1 7.874
Afa-150 1.70 0.744 y 5 0.889x 1 1.325 Aba-150 1.30 0.838 y 5 0.753x 1 3.604
Afa-160 1.54 0.905 y 5 0.829x 1 1.339 Aba-160 1.97 0.804 y 5 0.793x 1 1.514
Bfa-210 0.08 0.963 y 5 0.922x 1 3.145 Bba-210 0.45 0.944 y 5 0.927x 1 1.985
Bfa-220 0.45 0.728 y 5 0.769x 1 8.588 Bba-220 1.09 0.842 y 5 0.697x 1 8.889
Bfa-240 0.75 0.874 y 5 0.75x 1 6.110 Bba-240 1.25 0.756 y 5 0.752x 1 4.456
Bfa-250 1.70 0.783 y 5 0.655x 1 5.385 Bba-250 1.33 0.724 y 5 0.797x 1 3.065
Bfa-260 1.45 0.932 y 5 0.766x 1 1.769 Bba-260 1.10 0.766 y 5 0.641x 1 2.933
Mandible Mandible
Cfa-410 0.33 0.962 y 5 0.864x 1 4.942 Cba-410 0.32 0.984 y 5 0.918x 1 2.343
Cfa-420 0.82 0.835 y 5 0.909x 1 3.680 Cba-420 0.72 0.910 y 5 0.864x 1 4.418
Cfa-440 1.48 0.835 y 5 0.637x 1 7.718 Cba-440 1.35 0.786 y 5 0.571x 1 9.997
Cfa-450 1.80 0.882 y 5 0.751x 1 3.442 Cba-450 1.41 0.793 y 5 0.727x 1 4.247
Cfa-460 1.81 0.941 y 5 0.824x 1 0.590 Cba-460 1.69 0.862 y 5 0.633x 1 2.714
Dfa-310 0.46 0.952 y 5 0.89x 1 4.493 Dba-310 0.24 0.986 y 5 0.95x 1 1.610
Dfa-320 0.35 0.979 y 5 0.910x 1 3.419 Dba-320 0.94 0.919 y 5 0.879x 1 2.955
Dfa-340 1.50 0.843 y 5 0.805x 1 5.786 Dba-340 1.40 0.883 y 5 0.628x 1 8.965
Dfa-350 1.79 0.888 y 5 0.946x 1 2.440 Dba-350 1.95 0.782 y 5 0.494x 1 8.885
Dfa-360 1.73 0.946 y 5 1.033x 1 1.113 Dba-360 1.77 0.866 y 5 0.639x 1 2.767

American Journal of Orthodontics and Dentofacial Orthopedics February 2021  Vol 159  Issue 2