Contents

Proposed Titl

Contents........................................................................................................................................

List of Tables................................................................................................................................

List of Figures...............................................................................................................................

List of Abbreviations....................................................................................................................

1. Introduction...........................................................................................Error! Bookmark no

1.1. Background information........................................................Error! Bookmark no

1.2. Justification............................................................................Error! Bookmark no

2. Literature Review..................................................................................Error! Bookmark no

3. Research Hypothesis.............................................................................Error! Bookmark no

4. Aim and Objectives...............................................................................Error! Bookmark no

4.1. Aim.........................................................................................Error! Bookmark no

4.2. Objectives...............................................................................Error! Bookmark no

5. Materials and Methods..........................................................................Error! Bookmark no

5.1. Type of Study.........................................................................Error! Bookmark no

5.2. Place of study.........................................................................Error! Bookmark no

5.3. Study period...........................................................................Error! Bookmark no

5.4. Study population....................................................................Error! Bookmark no

5.5. Selection criteria.....................................................................Error! Bookmark no

5.6. Sample size determination and sampling procedure.................................................

Bookmark not defined.

5.7. Study procedure.....................................................................Error! Bookmark no

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 5.8. Data collection and analysis...................................................Error! Bookmark no

5.9. Operational (working) definition...........................................Error! Bookmark no

5.10. Study flow chart...................................................................Error! Bookmark no

6. Ethical Considerations..............................................................................................................

7. Conflict of Interest....................................................................................................................

8. Results (Dummy Tables/Pilot Study Results).....................................................

defined.

9. References.............................................................................................Error! Bookmark no

10. Plan of Action (Time Activity Schedule)...............................................................................

11. Appendices..............................................................................................................................

11.1. Appendix 1. Laboratory measurement recording form (Proforma)

.......................................................................................................Error! Bookmark no

11.2. Appendix 2. Data master sheet.............................................Error! Bookmark no

11.3. Appendix 3. Materials and chemicals.................................................

defined.

11.4. Appendix 4. Apparatus and equipment...............................................

defined.

11.5. Appendix 5. Photographs of materials, apparatus and equipment

.......................................................................................................Error! Bookmark no

11.6. Appendix 6. Photographs of pilot study.............................................

defined.

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 List of Tables

Table No. Page

Table 1. Measurement of flexural strength of Ashvin processed by

compression molding and injection molding techniques………….23
Table 2. Measurement of flexural strength of Yamahachi processed by
compression molding and injection molding techniques………….23
Table 3. Comparison of flexural strength of Ashvin processed by
compression molding and injection molding techniques………… 24
Table 4. Comparison of flexural strength of Yamahachi processed by
compression molding and injection molding techniques..……….. 24
Table 5. Comparison of flexural strength of Ashvin and Yamahachi
processed by compression molding technique ………………….. 25
Table 6. Comparison of flexural strength of Ashvin and Yamahachi
processed by injection molding technique………………………. 25

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 List of Figures

Figure No. Page

Figure 1. Heat cured acrylic resin (Yamahachi Basis HI) ………………..….34

Figure 2. Heat cured acrylic resin and resin separating agent (Ashvin)……..34

Figure 3. Apollon Sep - resin separating agent (Yamahachi)………………..35

Figure 4. Dental stone (Snow Rock, Mungyo Co. Ltd, Korea)……………….35

Figure 5. Universal testing machine (ZH-TB-500P – Sailham, China)……...36

Figure 6. Digital slide clipper (Hummer, Thailand)…………………………36

Figure 7. Snow Rock JetPAC injection machine (DK MUNGYO, Korea)......37

Figure 8. Laboratory incubator (Esco Isotherm, Singapore)…………………37

Figure 9. Showing – Acrylic strips invested in dental stone and each acrylic

strip was attached to sprue in an injection molding flask…………38

Figure 10. Mold space after deflasking………………………………………38

Figure 11. Acrylic samples before finishing...……………………………….39

Figure 12. Acrylic samples after finishing…………………………………...39

Figure 13. Acrylic strips invested in dental stone in a compression molding

flask……………………………………………………………….40

Figure 14. After closing the flasks for polymerization………………………40

Figure 15. Acrylic samples before finishing…………………………………41

Figure 16. Acrylic samples after finishing………………………………….. 41

Figure 17. Labelling of acrylic samples before measuring the flexural

strength……………………………………………………………… 42

Figure 18. Maximum deflection of specimen immediately before fracture….42

Figure 19. Fracture sample after 3-point loading test………………………..43

4
Figure 20. Load-deflection curve of a sample……………………………….43

5
 List of Abbreviations

ADA = American Dental Association

CAD/CAM = Computer Aided Design/ Computer Aided Manufacturing

SD = Standard Deviation

SPSS = Statistical Package for the Social Sciences

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 Proposed Title

Determination of mesiodistal crown width of the

permanent teeth in normal occlusion on three-dimensional
digital technique

7
8
1. Introduction
1.1 Background Information

Variation in tooth size dimension is influenced by genetic and

environmental factor. The term tooth size dimension refer to the mesiodistal
width of the teeth. Many studies reported that variation of tooth size exists
within the race and in subjects with different racial origin . In order to achieve
optimal occlusion maxillary to mandibular tooth width ratios must be
proportionate in size. The proportional relationship of tooth material of the
upper arch to lower arch is the prerequisite to achieve functional occlusion and
healthy maintenance of the system. Tooth size discrepancy is defined as a
disproportion among the size of individual teeth and the among the jaws. The
presence of inter-arch tooth size discrepancy lead to mal relationship between
the arches and with decreased functional efficiency and disfigurement in
esthetic harmony. A proportionate relationship between mesio-distal widths of
maxillary dentation to that of the mandibular dentation favours an optimal
post-treatment occlusion.

A specific dimensional relationship must exist between maxillary and

mandibular teeth to ensure proper interdigition, overbite, and overjet.
Becauspatient with interarch tooth size dimension discrenpacies require either
removal (eg, interdental stripping) or addition (eg, composite built up
/porcelain veeners) of tooth structure to open or closed spaces in the opposite
arch, it is important to determine the amount and location of tooth size
discrepancies before starting treatment.

Mesiodistal tooth width has an anthropological significance because it

provides valuable information on human evolution with its technological and
dietary changes. On clinical level, mesiodistal tooth width is correlated to the
arch alignment and large teeth are associated with crowded dental arches.
Moreover, a relationship has been noted between tooth size and third molar

9
eruption and impaction. Difference in tooth sizes have been associated with
different ethnic backgrounds and malocclusion. A comparative study between
Jordanians, Iraqi, Yemenites, and Caucasians reported that Jordanians and
Iraqis had larger teeth than the other populations.

Tooth size varies among different ethnic races. In an investigation of

tooth size of 139 swedish boys, lundstrom found that crowding was more in
indiv;iduals in with larger teeth. The results o f Fastlicht’s studies were
consistent with those of Lundstrom’s and reported a significant relationship
between tooth size and crowding. Doris et al found larger tooth size in
crowded cases rather than in the non-crowded cases, with the greatest
difference between the maxillary lateral incisor and second premolars.

The first investigation of mesiodistal width was studied by G.V Black

in 1902.He measured a large number of human teeth and from these
measurement he set up tables of mean figures, which are still used as
important references today. Several different investigators had followed
Black’s investigation with modification.

Many authors have evaluated factor associated with difference in

tooth width. The relationship between malocclusion type and tooth have
reported. Since differences in tooth size proportions have been reported
with ethnic groups. Bishara et al. conducted a study which include the
population of Egypt, Mexico and the United states . They noticed that
there was a difference in the mesiodistal dimensions of teeth among this
population. There was sexual dimorphism where males had larger teeth
than female in all three groups of population.

Till dates, few study on mesiodistal dimension of teeth of Myanmar

population are found in literature. This study is carried out to gather data
from universities on the mesiodistal width of permanent teeth and to see

10
the gender difference in tooth widths. This will help in orthodontics to
diagnose the case properly and finish the case with precise occlusion.

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1.2 Justification

The clinicians must be aware of the sizes of both individual teeth and
groups of teeth in order to provide an accurate diagnosis, determine the
proper course of treatment, ensure stable interdigitation, and precisely
predicted the results of orthodontic therapy. The orthodontic examination
must be concluded by determining the size and patterns of mesiodistal
crown-size relationships by analysis on conventional plaster study cast using
vernier calipers.

Population-specific norms of permanent tooth size are useful resources

for orthodontists and paedodontists in space analysis, prediction,
interception, and treatment of space-related malocclusion problems.

Normal measurement for one group should not be considered normal for
every race or ethnic group. Different racial group must be treated to their own
characteristics. Many studies have shown that there is a discrepancy of dental
volume between maxillary and mandibular arches, even in patients with
normal occlusion. Biometric norms are specific to an ethnic group cannot be
applied to other ethnic group as difference.

There has been limited research on the mesiodistal tooth size

dimension of permanent dentation on normal occlusion in communities of
Myanmar.

The spectrum of diagnostic instruments in medicine and orthodontics

has been expanded by contemporary imaging techniques and rapidly evolving
technologies and two-dimensional conventional method are being replaced by
three-dimensional imaging method. Therefore, a three-dimensional oral
scanner will be used to quantify the mesiodistal crown width in this study as it
has several advantages, such as improved accuracy and patient comfort.

12
This study is able to predict normative data on mesiodistal tooth size
dimensions in normal occlusion of regional population and conclude some
features of the normal occlusion in a sample of identical racial group, which
should apply on diagnosis process and may be relevant to future
anthropological and fundamental dental research as well as other clinical areas
of dentistry.

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 2.Literature Review

Mesiodistal tooth size measurement is an important step in the diagnostic process,

especially in management of complex cases. Santoro M, Ayoub ME, Pardi VA,
Cangialosi TJ. Mesiodistal crown dimensions and tooth size discrepancy of the
permanent dentition of Dominican Americans. Angle Orthod 2000; 0: 303-7.

The most common forms of malocclusion which are crowding and spacing are due to
the discrepancies of the size of the teeth and the size of the bony bases. Crowded
dental arches are associated with the large teeth relative to the size of the jaws and
small teeth are associated with the spaced dental arches, both conditions can be
localized to a few teeth or affect all teeth. Bermúdez de Castro JM, Nicolas ME.
Posterior dental size reduction in hominids: the Atapuerca evidence. Am J Phys
Anthropol 1995; 96: 335-56. 3 Al-Khateeb SN, Abu Alhaija ES. Tooth size
discrepancies and arch parameters among different malocclusions in a Jordanian
sample. Angle Orthod 2006; 76: 459-65. Failure to compensate for these
discrepancies during treatment generally results in unsatisfactory alignment and
occlusion of the teeth at the end of orthodontic treatment.

An optimal orthodontic outcome is dependent on the relative sizes of maxillary and

mandibular teeth to each other which has been referred to as the “seventh key” in
addition to Andrew’s six keys to optimal occlusion. McLaughlin RP, Bennett JC,
Trevisi HJ. Systemized Orthodontic Treatment Mechanics. St. Louis: Mosby; 2001. p.
285.

Proffit and Fields suggest tooth width discrepancy larger than 1.5 mm be included in
the problem list since it may cause difficulties in treatment. Proffit WR, Fields HW,
editors. Orthodontic diagnosis: The development of a problem list. In: Contemporary
Orthodontics. St. Louis, Mo: Mosby Inc.; 2007. p. 201. 5.

Teeth size variations depend on racial, heredity, gender and environment factors.
There are many literatures based on causative factors of tooth size discrepancies.

Black (1902) was one of the first investigators to measure tooth sizes and his tables
of mean tooth sizes are still used today. Black GV. Descriptive anatomy of the human
teeth. 4th ed. Philadelphia: SS White Dental Mfg. Co., 1902. He measured a large
number of human teeth and established the table of human figure of the toot size.

14
Nelson (1938) compared the mesiodistal diameter of Pecos Pueblo Indian and found
the teeth to be larger than values reported by G.V Black.

Wheeler published the standard dimension of tooth size in order that the teeth
many be curve and articulated in an ideal manner. Wheeler RC. A textbook of dental
anatomy and physiology. 1950 Ballard measured 500 sets of models, evaluating
asymmetry in tooth sizes. Ninety percent of his sample showed a right-to-left
discrepancy of 0.25 mm or more in the mesiodistal width of one or more pairs of
teeth. His observations led to the conclusion that asymmetry is the rule, not the
exception, and that judicious enamel reduction or “stripping” is sometimes
necessary, particularly in the anterior segments to gain proper interdigitation of
teeth. Bllard ML Asmmetry in tooth size; a factor in the diagnosis and treatment of
malocclusion

Neff measured the mesiodistal dimensions of the maxillary and mandibular teeth of
200 patients. He developed an “anterior coefficient” by dividing the sum of the six
maxillary anterior teeth by the mandibular mesiodistal sum. Neff CW. Tailored
occlusion with the anterior coefficient. AM J ORTHOD 1949;35:309-14. Neff then
correlated these ratios to the amount of overbite and concluded that a 20% overbite
with a coefficient of 1.20 to 1.22 mm was ideal; the value of 1.17 mm was associated
with an edge-to-edge incisor relationship and the other extreme of 1.41 mm was
associated with a deep overbite relationship.

Lundstrom studied 319 sample of 13-year-old children and reported on the

variation in intermaxillary tooth width ratio. The mesiodistal widths were recorded
and the dispersion for the three tooth size indices were calculated. Lundstrom A.
Intermaxillary tooth width ratio and tooth alignment and occlusion. Acta Odontol
Stand 19.54; 12:265-92. His results demonstrated a large biologic dispersion in the
tooth width ratio. It was great enough to have an impact on the final tooth position,
teeth alignment, and overbite and overjet relationships in a large number of these
patients. This same formula originally was developed by Bolton’ to observe
mesiodistal tooth size discrepancies.

MOORREES (1957) measured the dentation of Alaskan Aleuts and compared them to
North American Caucasians. He found that the teeth from first molar are slightly
larger in the Aleuts, with a relatively smaller difference in the size of the central and
lateral incisor.

In 1958, Bolton published his work on interpreting mesiodistal tooth size

dimensions and their effect on occlusion. Bolton A. Disharmony in tooth size and its
relation to the analysis and treatment of malocclusion. Angle Orthod 1958;28:113-
30.Bolton selected 55 cases with excellent occlusions, most of which (44) had been

15
treated orthodontically (non-extraction). Needle-pointed calipers were used to
measure the mesiodistal widths in both the maxillary and mandibular arches from
first molar to first molar. The mesiodistal widths of the 12 maxillary teeth (first molar
to first molar) were totaled and compared with the sum derived by the same
procedure carried out on the 12 mandibular teeth. The ratio derived between the
two is the percentage relationship of mandibular arch length to maxillary arch
length. He concluded that an overall ratio of 91.3 and an anterior ratio of 77.2 were
necessary for proper coordination of the maxillary and mandibular teeth.

Stifter replicated Bolton’s study and reported similar results. Stifter J. A study of
Pont’s, Howes’, Rees’, Neff ‘s and Bolton’s analyses on Class I adult dentitions. Angle
Orthod 1958; 28:215.He also the validity of the Pont, Howes, Rees, Neff and Bolton
analysis on class I dentations. These indices are used to predict final tooth position.
He figured out the overall ratio of 91.04 and the anterior ratio of 77.5 and
concluded that the percentage relationship of the lower to the upper anterior tooth
size was a significant consideration when attempting to harmonize tooth material.

Mesiodistal tooth size problems were discussed again in 1962 by Bolton. Bolton WA.
The clinical application of a tooth size analysis. AM J ORTHOD 1962;48:504-29. He
presented several cases to document the effectiveness of his analysis clinically. He
verified the importance of analyzing mesiodistal arch dimension.

Moorrees and Reed were the first on measuring the tooth with dental model.
Moorrees CFA, Reed RB; Correlation among crown diameter of human teeth. Arch
Oral Biol, 1965.By using sliding caliper with a vernier scale, they measured
mesiodistal diameter of tooth at mesial and distal contact point parallel to the
occlusal plane and vestibular surface of the model. Doris et al confirmed this
measurement Doris JM, Bernard BW, Kuftinec Mm; A biometric study of tooth size
and dental crowding Am J Orthod Dentofacial Orthop 1981

Huang, Miura and Soma conducted a dental anthropological study of Chinese in

Taiwan. Huang ST,Miura F ,soma K:A dental anthropological study of Chinese in
Taiwan .Teeth size, dental arch dimensions and forms. Gaoxiong Yi Xue Ke Xue Za Zhi
6;12-635-643, 1991.They compared the data with Japanese, Central and South
American Indians and North American Caucasians. The crown size of the Chinese
male was smaller than those of other four races, especially the upper canine, lower
central incisor and first molar. The Chinese females possessed smaller upper central
incisor and larger upper premolar compared to those of the North American.

16
Merz, Isaacson, Germane et al. found that the Black subject’s mean canine, first and
second premolar, and first molar diameters were significantly larger than those of
the Whites. Merz ML, Isacson RJ, Germane N, Rubenstein LK; Tooth diameters and
the arch perimeters in a black and a white population. Am J Orthod Dentofacial
Orthop, 100;1:53-58, 1991.

Otuyemi and Noar compared the mesiodistal crown dimension of the Nigerian and
British population. Otuyemi and Noar JH: A comparison of crown size dimensions of
the permanent teeth in a Nigerian and a British population. Eur J ORthot. 18:623-
628, 1996. The result indicate that the crown diameters were consistently larger in
the Nigerian sample.

Karanth and Jayade established oriental norms for the average tooth size of a
Tibetan population. Karanth DHS, Jayade VP: An odontometric study of a Tibetan
population. Aus Ortho J, 15:2:93-99, 1998.The study showed that Tibetan teeth were
broad and short. The Tibetans possessed wider teeth than the Caucasians except for
the central incisors of both arches and the lower second premolars. The tooth
diameters were larger, especially in the case of upper laterals, first premolars, and
first molars in both arches.

Keene reported racial differences in tooth sizes among the American Negroes and
their Caucasian counterparts in caries free naval recruits. Keene H J Mesiodistal
crown diameters of permanent teeth in male American Negroes. Am J
Orthod .1979;76: 95-99. Turner and Richardson also observed significant differences
in mesiodistal tooth width in Kenyan and Irish populations.

In another related study Bishara compared the mesiodistal and buccolingual crown
dimensions of the permanent teeth in three populations from Egypt, Mexico and the
United States. Bishara SE, Jakobsen JR, Abdallah EM, Garcia AF. Comparisons of
mesiodistal and buccolingual crown dimensions of the permanent teeth in three
populations from Egypt, Mexico and the United States. Am J Orthod & Dentofac
Orthoped. 1989;96:416-22 The results from this study indicated statistically
significant differences in the mesiodistal dimension among the three populations.
There was sexual dimorphism where males had larger teeth than females in all three
groups of population.

17
Bolton’ analysis was concluded that relatively small range at which tooth size ratio
fall, there is tendency to achieve normal occlusion. It is very useful in the clinical
setting of orthodontics in case with extreme tooth size discrepancies. So many
authors apply this normal value of Bolton’ normal value in different race finally
found that there was significant difference among different racial and ethnic group
and many normal standards have been developed.

Smith et al derived data from systematically collected pre-orthodontic casts of 180

patients, including 30 men and 30 women from each of black, Hispanic, and white
groups1. Smith SS, Buschang PH, Watanabe E. Interarch size relationships of 3
populations: does Bolton’s analysis apply? Am J Orthod Dentofacial Orthop
2000;117:169-74.. They concluded that Bolton ratios apply to white women only;
the ratios should not be indiscriminately applied to white men, blacks, or Hispanics.

Lew and Keng, studying a group of Singaporian Chinese, reported an anterior ratio
comparable with the Bolton standard, even though Singaporean Chinese had smaller
maxillary central incisors and larger maxillary lateral incisors. Lew KK, Keng SB.
Anterior crown dimensions and relationships in an ethnic Chinese population with
normal occlusions. Aust Orthod J 1991;12:105-9. Mesiodistal tooth sizes in southern
Chinese people were found to be generally larger than those of other Chinese
subraces or whites.9. Ta TA, Ling JYK, Hägg U. Tooth-size discrepancies among
different occlusion groups of southern Chinese children. Am J Orthod Dentofacial
Orthop 2001;120:556-8. 10. Tsai GS. The Chinese dentition. III. Mesiodistal crown
diameters of permanent and deciduous teeth. J Formosa Med Assoc 1970; 28:45-50.
Variation in mesiodistal dimensions could affect the anterior and overall ratios
between the maxillary and mandibular teeth. Moorrees CFA. The Aleut dentition.
Cambridge (Mass): Harvard University Press; 19

Mamound NM, Eltahir HE and Mageet AO 2017 reported Sudanese population show
slightly higher than Bolton’anterior ratio. Gsnesh Mahankudo, Chetan Patil, M.
Balagangadhr, V. Raghavendra, Prajyot Marawade and Sagar Salunke reported
Karnataka population subjects were different from Bolton’value. So Bolton value
cannot be use for Karnataka population and specific norm needed. Yachana Vipul,
Vivek Shilpa and Chawla Jamenis on Maratha population in Pune suggested
population specific standard are necessary for clinical assessment as these
population differ from the Bolton’s value of Caucasian population.

18
Tancan Uysal and Zafer Sari on article of intermaxillary tooth size discrepancy and
mesiodistal crown dimension for Turkish population propose that Bolton’s original
data does not represent Turkish people and so population specific normative study
was performed.

S.A. Othman, H. Mookin, M.A. Asbollah, N.A. Hashim. Bolton tooth-size

discrepancies among University of Malaya's dental students. Annal Dent Univ
Malaya 2008; 15(1): 40-47 on article BOLTON TOOTH-SIZE DISCREPANCIES AMONG
UNIVERSITY OF MALAYA'S DENTAL STUDENTS concluded that 47.5% of the sample
had anterior, and 10% had overall ratios greater than 2 standard deviations from
Bolton's mean. These figures indicate that high percentage of the dental students of
the University of Malaya has TSD outside of Bolton 2 standard deviations. It would
seem prudent to routinely perform the tooth-size analysis and include the finding
into orthodontic treatment planning.

Garn and Lewis in 1958 showed the strong evidence of genetic influence on the
human teeth. They observed marked racial difference in tooth size. The genetic basis
for this variation is best explained by polygenic model of inheritance by Lundstrom.
Lundstrom A size of teeth and jaws in twin Br Dent J 1964 ;117.He concluded that
tooth size within a given population is determined to a large extent by genetic
factor.

Kalia quoted according to Townscend, the difference in size has been attributed to
differently balanced hormonal production between male or female gonads during
sixth or seventh week of embryogenesis .Kalia S Study of permanent maxillary and
mandibular canine and intercanine arch width among male and female 2006

Seipel” found less pronounced sex differences in the deciduous dentition than in
the permanent dentition. Seipel, C. M.: Variation of tooth position, Svensk. Tandiak.
Tidskr. 39 (Supp.): 50-51, 1946. 11. Sokal, Sex difference was maximum for
deciduous and permanent canines, while incisors showed a minimum and premolars
showed an intermediate difference. All the sex differences were significant, in the
permanent dentition. These observations were substantiated by Moorrees,” who
found the male teeth to be invariably bigger than the female teeth, sex differences
in mesiodistal tooth size to be greater in the permanent than in the deciduous
dentition, and the largest sex differences in the canines in both dentitions.
Moorrees, C. F. A.: The dentition of the growing child, Cambridge, 1959, Harvard
University Press, pp. 79-86..

Garn, Lewis, and Kerewsky” determined the sex difference in mesiodistal diameters
of the permanent teeth to be 4 percent of the combined size. The sex difference was
greatest for the canines and smallest for the incisors in the permanent dentition.

19
Garn, S. M., Lewis, A. B., and Kerewsky, R. K.: Sex difference in tooth size, J. Dent.
Res. 43: 306, 1964. 4.

Beresford found the average tooth size for girls to be slightly but significantly less
than the average tooth size for boys in the case of every tooth from the central
incisors to the first permanent molars. Beresford, J. 8.: Tooth size and class
distinction, Dent. Pratt. 20: 113-120, 1969. Similarly, Sanin and Savara found the
median mesiodistal crown diameters to be larger for boys than for girls in all teeth
except the lower central incisors. Sanin, C, and Savara B S ;An analysis of
permanent mesiodistal crown size ,A M J Ortho.1971

Lavelle also observed the tooth dimensions to be greater in males than in females.
Lavelle, C. L. B.: Maxillary and mandibular tooth size in different racial groups and in
different occlusal categories, AM J. ORTHOL). 61: 29-37, 1972. Potter” found the
mesiodistal diameter of all permanent teeth except the maxillary lateral incisors,
mandibular central incisors, and mandibular second premolars to be significantly
larger in males than in females. Potter, R. H. Y.: Univariate versus multivariate
differences in tooth size according to sex,J. Dent. Res. 51: 716-722, 1972.

Khangura et al exhibited maxillary canine dimorphism. Khangura RK, Sircar K, Singh

S, Rastogi V. Sex determination using mesiodistal dimension of permanent maxillary
incisors and canines. J Forensic Dent Sci. 2011; 3(2): 81-85. Otuyemi and Noar also
showed dimorphism in maxillary canines bilaterally. Otuyemi OD, Noar JH. A
comparison of crown size dimensions of the permanent teeth in a Nigerian and
British population. Eur J Ortho 1996; 18: 623-28

Kaushal et al and Garn et al who also reported statistically significant sexual

dimorphism for mandibular canine. Kaushal S, Patnaik VVG, Agnihotri G. Mandibular
canines in sex determination. J Anat Soc. India 2003; 52(2): 119-24. And Garn SM,
Lewis AB, Swindler DR, Kerewsky RS. Genetic control of sexual dimorphism in tooth
size. J Dent Res. 1967; 46(5): 963-72. Arya et al showed that there were differences
in tooth size between sexes as reported by other authors. Arya BS, Savara BS,
Thomas D, Clarkson Q. Relation of sex and occlusion to mesiodistal tooth size. Am J
Orthod 1974;66:479- 86.

KELLAM (1982) compared tooth measurement of 40 Navajo Indian from Shiprock,

New Mexico to 40 Caucasian patient from orthodontics department at the university
of Iowa. He found the sum as well as individual tooth diameter to be greater in
Navajos than in Caucasian. In addition, both groups exhibited sex difference in the

20
size of maxillary and mandibular cuspid, with males having larger teeth than
females.

Moorrees, Thomsen and Jensen et al found that the tooth crowns of the males were
broader than those of the females in North American subjects. Moorrees CFA,
Thomsen S, Jensen E, Yen PK: Mesio-distalcrown diameters of the deciduous and
permanent teeth in individuals. J Dent Res, 36:1:39-47, 1957 The sex difference was
most pronounced in canines.

Richardson and Malhotra" reported tooth size of the males were larger than those
of the females for each tooth type in both arches in American Negroes. Richardson
ER ,Malhotra SK ; Mesiodistalcrown dimension of the permanent dentation of
American Negroes Am J Orthod 1975 Doris, Bernard and Kuftinec determined that
the tooth size in North American males were uniformly larger than those in females,
but not to a significant level.Doris JM, Brrnard BW , Kuftinec MM ;Abiometric study
of tooth size and dental crowding Am J OrthodDentofacial Orthop 1981

Yuen, So and Tang studied the mesiodistal crown diameters of the Southern Chinese
population of Hong Kong. 12. Yuen Keith KW, So Lisa LY, Tang Endara LK: Mesio-
distal crown diameters of the primary and permanent teeth in Southern China - a
longitudinal study. Eur J Orthod,19: 721-731, 1997I They concluded that none of the
teeth showed significant sex difference in bilateral asymmetry, except for the upper
primary second molars. The male teeth were larger than the female teeth except for
the lower central incisors and lateral incisors.

Alok Kumar Jaiswal, Umesh Parajuli, Manish Bajracharya and Binita Singh on the
article Mesiodistal crown width in permanent dentition amongst adolescent
population of Province II of Nepal stated that the mean mesiodistal crown
dimensions of the permanent dentition of males were larger than that of females for
each type of tooth except maxillary central and lateral incisor. ( April 2020)

In 1923 Gilpatric calculated the total mesiodistal tooth diameter in the maxillary
arch exceeded that in the mandibular arch by 8 to 12mm.Gilpatric WH. Arch
predeterimination_is it pratical Am J Dent ASSoc July 1923. Tancan Uysala and Zafer
Sarib concluded that the greater size variability was found in maxillary teeth
compared with mandibular teeth. The first molars and the maxillary lateral incisors
had significant variability, and these teeth should be examined clinically to exclude
any major size and shape discrepancies on the article Intermaxillary tooth size
discrepancy and mesiodistal crown dimensions for a Turkish population. ( Apirl
2004)

21
Ballard resulted that 90 % of his sample showed a right left discrepancy in
mesiodistal width equal to or exceeding 0.25mm. Ballard ML (1994) Asymmetry in
tooth size; a factor in the etiology, diagnosis and treatment of malocclusion Angle
orthd 14;67-Murshid and Hashim reported the mesiodistal crown diameter in a
Saudi Arabian population. Murshid Z, Hashim HA; Mesiodistal tooth width in Saudi
Arabian population; A preliminary report The Saudi Dent J , 5;2;68-72,1993.They
found that the first molar exhibited the least coefficient of variation while the
central and lateral showed the most. The values in the right side of the upper arch
were relatively greater than those in the left side, which are not true for the lower
arch.

Imaging is one of the most important diagnostic tools of orthodontists, used to

assess and record the size and shape of the craniofacial structures. Nowadays, the
routine techniques of two-dimensional static imaging are being replaced by three-
dimensional imaging, which gives the possibility of assessing the depth of structures.
3D imaging was developed in the early 1990s and is still subject to further
modifications. These technologies can be non-invasive, e.g., using magnetic
resonance, ultrasound, visible light, and laser, or invasive based on X-rays. The first
digital imaging technologies adopted by orthodontists were the photograph,
orthopantomography, cephalometry, and periapical tissue imaging. It should be
mentioned that soft and hard facial tissues and dentition are the three main
elements, also called triads, analyzed in det ail in orthodontics and orthognathic
surgery. Plooij, J.; Maal, T.; Haers, P.; Borstlap, W.; Kuijpers-Jagtman, A.; Berge, S.
Digital three-dimensional image fusion processes form planning and evaluating
orthodontics and orthognathic surgery. A systematic review. Int. J. Oral. Maxillofac.
Surg. 2001, 40, 341–352 Therefore, imaging those structures is one of the important
diagnostic tools for clinicians in making decisions about the treatment method.
Mavili, M.; Canter, H.; Saglam- Aydinatay, B.; Kamaci, S.; Kocadereli, I. Use of three-
dimensional medical modeling methods for precise planning of orthognathic
surgery. J. Craniofac. Surg. 2007, 18, 740–747

Orthodontic models are an indispensable diagnostic tool for an orthodontist. it can

carry out a thorough analysis of the size, shape and position of the teeth, the shape
of the dental arches, and to determine the mutual relations between them. In
addition, individual orthodontic appliances or their individual components are made
in the laboratory on orthodontic models. 4. Premkumar, S. Textbook of
Orthodontics; Elselvier: Amsterdam, The Netherlands, 2015; pp. 365–367. Until
recently, orthodontic plaster models were the only available three-dimensional
information carrier that accurately reflected the patient’s occlusal situation

22
Due to the development of computer techniques and the introduction of oral tissue
scanning methods, it became possible to create three-dimensional digital
orthodontic models. 5. Jedlinska, A. The comparison analysis of the line
measurements between plaster and virtual orthodontic 3d models. Ann. Acad. Med.
Stetin. 2008, 54, 106–113.

There are two methods of creating a virtual model. The first one is the direct
technique, where during the examination of the patient with the help of specialized
visualization techniques, e.g., with the use of computer tomography, magnetic
resonance, or in the process of intraoral scanning with the use of an intraoral
scanner, records of the oral cavity conditions are made in the form of a file. In order
to obtain a complete picture of the dental arch, it is necessary to scan five areas: the
buccal, occlusal and lingual surfaces, as well as the proximal and distal interdental
surfaces. 6. Truszkowski, M. Three-dimensional imaging in orthodontics. Orthop.
Lucky Orthod. 2002, 4, 19–21

The second option is indirect scanning, which consists of scanning a previously made
plaster model in a traditional way after taking impressions in the patient’s mouth
using the impression material or scanning the impressions themselves. This method
uses non-contact optical scanning processes using a laser, white light, or
piezoelectric tactile light. There are also destructive techniques consisting of
analyzing the solid plaster model by revealing its successive sections by shearing
layers of a predetermined thickness with simultaneous recording. Layers are imaged
with a scanner, and a digital record of the model is generated using specialized
computer software [7] Jaworski, S. 3D Modeling and Reverse Engineering
Technology in Orthodontic Diagnostics. Bachelor’s Thesis, University of Technology
Wroclawska, Wrocław, Poland, 2004; pp. 31–35

Three-dimensional digital impressions were first introduced in 1987 by CEREC 1

(Siemens, Munich, Germany) using an infrared camera and optical powder
distributed over the tooth surface. Over the years, the development of computer
hardware and software has radically improved the technologies, making them much
faster and simpler replacing traditional impressions with the use of impression
material in many dental and orthodontic offices.

Computer-aided design and manufacturing (CAD/CAM) systems are based on three

basic steps: (1) data collection and digitization, (2) data processing and design, and
(3) production. The development of digital impressions made it possible to create
high-resolution virtual 3D models [8,9]. 8. Patzelt, S.; Bishti, S.; Stampf, S.; Att, W.
Accuracy of computer-aided design/computer-aid manufacturing-generated dental

23
casts based on intraoral scanner data. J. Am. Dent. Asso. 2014, 145, 1133–1140. 9.
Logozzo, S.; Zanetti, E.; Franceschini, G.; Kilpela, A.; Makynen, A. Recent advances in
dental optics-Part I: 3D intraoral scanners for restorative dentistry. Opt. Lasers Eng.
2014, 54, 203–221. Mapping the structures of the teeth and surrounding tissues is
carried out using non-contact optical technologies.

The negative aspects of traditional impressions are discomfort for the patient,
inaccuracy or work in the laboratory, are eliminated. Although plaster models have
been used for years as routine dental records for analyzing dentition, they
nonetheless have several disadvantages. They are time-consuming, space-
consuming to store, brittle, degrading and can be damaged when handled

Thus, digital models are an alternative to traditional plaster models. Their

advantages in orthodontic diagnosis and treatment planning include easy and fast
electronic data transfer, immediate access, and reduced space requirements [10].
10. Kravitz, N.; Groth, C.; Jones, P.; Graham, J.; Redmond, W. Intraoral digital
scanners. J. Clin. Orthod. 2014, 48, 337–347 The emergence of new technological
solutions has become the subject of research on the compliance and reliability of
measurements of plaster models and digital models. The first studies concerned the
analysis of digital models obtained by scanning plaster models with a 3D model
scanner. Most researchers have shown that a digital model scanned with a 3D model
scanner shows high accuracy compared to conventional plaster models [11– 14]. 11.
Motohashi, N.; Kuroda, T. A 3D computer-aided design system applied to diagnosis
and treatment planning in orthodontics and orthognathic surgery. Eur. J. Orthod.
1999, 21, 263–274. 12. Zilberman, O.; Huggare, J.; Parikakis, K. Evaluation of the
validity of tooth size and arch width measurments using conventional and three-
dimentional virtual orthodontic models. Angle Orthod. 2003, 73, 301–306. 13.
Fleming, P.; Marinho, V.; Johal, A. Orthodontic measurements on digital study
models compared with plaster models: A systematic review. Orthhod. Craniofac.
Res. 2011, 14, 1–16. 14. Rossini, G.; Parrini, S.; Castroflorio, T.; Deregibus, A.;
Debernardi, C. Diagnostic accuracy and measurment sensitivity of digital models for

24
orthodontic purposes: A systematic review. Am. J. Orthod. Dentofac. Orthop. 2016,
149, 161–170.

Some researchers reported that digital models provide more accurate imaging than
the plaster model. Mullen, S.; Martin, C.; Ngan, P.; Gladwin, M. Accuracy of space
analysis with emodels and plaster models Am. J. Orthod. Dentofac. Orthop. 2007,
132,

Accurately positioning a thin and small cursor anywhere in the tooth being
measured is much easier than using the oversized caliper gauge used for
measurements on plaster models. The scanning procedure itself takes less time at
the dentist’s chair and is less unpleasant for the patient than a standard dental
impression. It was also published that patients, when asked which method of taking
impressions was more satisfactory for them, definitely chose virtual techniques. An
important fact is noted by Solabrietta et al., who claim that these two techniques
should not be compared because facilitating the dentist’s daily work and improving
the patient’s comfort should always be of the highest priority [31,32]. 31.
Solaberrieta, E.; Garmendia, A.; Brizuela, A.; Otegi, J.R.; Pradies, G.; Szentpétery, A.
Intraoral Digital Impressions for Virtual Occlusal Records: Section Quantity and
Dimensions. Biomed. Res. Int. 2016, 2016, 7173824. 32. Wesemann, C.; Muallah, J.;
Mah, J.; Bumann, A. Accuracy and efficiency of full-arch digitalization and 3D
printing: A comparison between desktop model scanners, an intraoral scanner, a
CBCT model scan, and stereolithographic 3D printing. Quintessence Int. 2017, 48,
41–5

The accuracy and reliability of measurements carried out using software on digital
models are widely confirmed by the literature [21-24]. [21] Gracco A, Buranello M,
Cozzani M, Siciliani G. Digital and plaster models: a comparison of measurements
and times. Prog Orthod 2007; 8(2):252-9. [22] Tarazona B, Llamas JM, Cibrián R,
Gandía JL, Paredes V. Evaluation of the validity of the Bolton Index using conebeam
computed tomography (CBCT). Med Oral Patol Oral Cir Bucal 2012; 17(5):e878-83.
https://doi.org/10.4317/medoral.18069 [23] Zilberman O, Huggare JA, Parikakis KA.

25
Evaluation of the validity of tooth size and arch width measurements using
conventional and three-dimensional virtual orthodontic models. Angle Orthod 2003;
73(3):301-6. [24] Wan Hassan WN, Othman SA, Chan CS, Ahmad R, Ali SN, Abd
Rohim A. Assessing agreement in measurements of orthodontic study models:
Digital caliper on plaster models vs 3-dimensional software on models scanned by
structured-light scanner. Am J Orthod Dentofacial Orthop 2016; 150(5):886-95.
https://doi.org/10.1016/j.ajodo.2016.04.021Indeed, especially in crowding cases,
measuring teeth size on plaster casts is imprecise due to the difficulty in identifying
the mesial and distal contacts of teeth. On the other hand, the same procedure is
easier if done on digital models since we have the possibility to rotate and enlarge
the 3- dimensional model [21]. Gracco A, Buranello M, Cozzani M, Siciliani G. Digital
and plaster models: a comparison of measurements and times. Prog Orthod 2007;
8(2):252-9.

Zilberman et al. [25] compared the accuracy and repeatability of the analyzes
performed on plaster casts and those performed digitally with 3D software. These
researchers concluded that digital measurements produce high clinical accuracy and
must be taken into consideration for research study work. Zilberman O, Huggare JA,
Parikakis KA. Evaluation of the validity of tooth size and arch width measurements
using conventional and three-dimensional virtual orthodontic models. Angle Orthod
2003; 73(3):301-6. Wan Hassan et al. confirmed the same result: there are no
significant differences between manual and digital measurements, as they all
represent a valid and reliable alternative in orthodontic practice. Wan Hassan WN,
Othman SA, Chan CS, Ahmad R, Ali SN, Abd Rohim A. Assessing agreement in
measurements of orthodontic study models: Digital caliper on plaster models vs 3-
dimensional software on models scanned by structured-light scanner. Am J Orthod
Dentofacial Orthop 2016; 150(5):886-95.
https://doi.org/10.1016/j.ajodo.2016.04.021

On a digital model, there are advantages. The portability is just one. It is true that a
digital model may be promptly delivered via email, which is quite helpful when
working with other authorities. Time is saved by not needing to physically replicate
the cast. The same authors noted that intraoral scanners allowed for advancements

26
in orthodontics like aligners, further customizing orthodontic appliances like
removable retainers, monitoring dental movement through digital model
superimposition, and last but not least, more accurate diagnosis, treatment
planning, and even simulation of potential orthodontic movement on correct
software.

It should be mentioned that intraoral scanners and the obtained virtual impressions
have streamlined and improved the quality of some modern techniques of
orthodontic treatment. Using the width of the teeth is important during treatment,
for example, with the Invisalign method. The interest of patients in this method of
treatment, due to the wearing of dental trays instead of orthodontic brackets, is
constantly growing. Determining the width of the teeth on the virtual models helps
in starting the orthodontic stripping treatment and setting the correct dental arch in
the program. Jedli ´nski, M.; Mazur, M.; Grocholewicz, K.; Janiszewska-Olszowska, J.
3D Scanners in Orthodontics-Current Knowledge and Future Perspectives-A
Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 1121.

Digital models are also an excellent tool for patient education. The younger
generation of patients currently in treatment are familiar with computers and are
comfortable with computer-generated images. They can relate to digital models and
probably expect to see this technology when they visit their orthodontists. Digital
models can be shown to the patient and their guardians during treatment
conferences, during treatment, and at the conclusion of treatment to illustrate the
improvement in their dentition. There are also services that will set up secure Web
sites that contain patient records and treatment information so that the patient can
view these images from their home. Ultimately, digital models improve
communication between the clinician and the patient, enhancing informed consent.

The digital models available today offer seamless integration into most of these
management and imaging systems. Digital models are part of the totally digital
orthodontic office

27
3.Research Hypothesis

28
 4. Aim and Objectives

4.1. Aim

To determine the mesiodistal crown dimension of permanent

teeth in normal occlusion.

4.2. Objectives

1. To measure the mesiodistal crown width of individual tooth in males

2. To measure the mesiodistal crown width of individual tooth in females
3. To compare the mesiodistal crown width of maxillary teeth between male and
females
4. To compare the mesiodistal crown width of mandibular teeth between male
and female
5. To compare the mesiodistal crown width between right and left sides of
maxillary and mandibular teeth in males
6. To compare the mesiodistal crown width between right and left sides of
maxillary and mandibular teeth in females

29
5. Materials and Methods

5.1 Type of study

Cross-sectional descriptive study

5.2 Place of study

Department of Orthodontics, University of Dental Medicine,

Mandalay

5.4 Study Population

Young adult with fulfil of inclusion criteria who are willing to

participate in this study will be selected.

5.5 Selection of subjects

5.5.1. Inclusion Criteria/ Exclusion Criteria

(1) Inclusion Criteria

a. 16 – 30 years old participants exhibit a straight profile

b. No previous orthodontic treatment
c. Permanent dentition with the exception of third molars
d. Angle’s class I molar relation bilaterally
e. Normal overjet and overbite (1-3mm) Pesqui. Bras.
Odontopediatria Clín. Integr. 2021; 21(supp1):e0023 :
Lombardo et al . (Am J Ortho Dentofacial Ortho
2016;150:105-15
f. Minimal crowding (less than 2 mm) and minimal spacing (less
than 1 mm) S-J. Lee et al. European Journal of Orthodontics
33 (2011) 9–14

30
 (2) Exclusion Criteria

a. Craniofacial anomalies
b. Cleft lip, palate and other syndrome
c. Congenital dental anomalies in tooth number, size and shape
d. Presence of interproximal restorations, caries, attrition and
fractures that would affect the mesiodistal crown morphology
of the teeth
e. Retained deciduous teeth
f. History of trauma and prosthodontics treatment

5.6 Sampling Method and Sample Size

Sampling Method

Sample size

5.7. Study procedure

The samples will be collected and explained about the

research and will request to participate in this study. The informed
consent will be signed by each participant and then, they will be
examined with illuminated light using mouth mirror, probes and
tweezers.
The participants fulfil with inclusion criteria will be taken
digital impression with 3Shape intraoral scanner. When intraoral

31
scanning is operating, the manufacturer’s instructions will be taken
into account. The scanner tip will be placed at an angle of forty-
five degrees to the tooth axis or as close to such angle as possible.
In order to perform the procedure correctly, the surface of
the teeth will be initially dried with compressor air, and then
intraoral scanning will be done using 3Shape scanner with a sterile
scanner head, starting from the most distal tooth in right quadrant
of the maxillary arch continuing to the anterior teeth and ended at
the most distal tooth in left quadrant of the that arch on occlusal
sweep, the second sweep is buccal side and the last sweep is palatal
side
The mandibular arch is started scanned from the left side, where
the palatal sweep of the upper scanning is finished at that side. The
second side is the lingual side, and the operation is finished with
buccal side scanning
After scanning, the electronic files will be transformed into
digital models. The digital models will be measured between
anatomic mesial and distal contact points of both arches using a
digital caliper of 3Shape Orthoanalyzer software with an accuracy
of 0.01 mm. The necessary measurements will be made in the
occlusal view for improved visibility. The rotation and zooming
functions will be used to find a precise location and more
convenient perspective for the measurements during virtual model
analysis for convenience and accuracy. (Figures).

The mesial and distal contact points will be identified and

marked using OrthoAnalyzer 3Shape software. The widest distance
between the contacts points will serve as the mesiodistal width of
each tooth's measurement. The measurement will be performed on

32
 the labial surface at the incisors and canines. The measurements
will be carried out on the occlusal plane on premolars and molars.

The values will be calculated automatically by the software,

once the mesial and distal points were marked. A total of 28 teeth
will be measured, excluding the last molars.
For intra-examiner reliability evaluation, the same examiner
will repeat the measurements at 2 weeks interval. The average
value of the two measurements will be used as the stable results of
the digital method for subsequent comparison.
Male and female groups will be illustrated using the data of
the mesiodistal crown of each individual tooth dimensions of both
arches. The data will summarize and compare the mesiodistal
crown width of maxillary and mandibular teeth between male and
female groups. Then, the comparison between mesiodistal crown
width of the right and left sides of both arches on male group and
that comparison on female group will be done.

Scan paths of Upper Arch: Occlusal, Facial (Buccal) and Lingual, then
Palatal

33
Scan path of Lower Arch: Occlusal, Lingual and Facial (Buccal)

34
5.8Data collection and analysis

35
 5.9. Operational (working) definition

Mesiodistal tooth size dimension = Maximum mesiodistal width between

anatomical mesial and distal contact point of the tooth

Straight facial profile = facial curvature when viewed in profile is

neither convex (curving outward) nor concave (curving inward) clinically, on
placing the patient in natural head position either sitting or standing and
looking at distant object

Occlusion =Any contact between the teeth of opposing

dental arches, usually referred to contact between the occlusal surface

Normal Occlusion =The Mesiobuccal cusp of upper first

permanent molar occluded into the buccal developmental groove of lower first
permanent molar (Angle’ class I molar classification). The teeth are arranged
in smoothly curving line of occlusion and that are satisfy the requirement of
function and aesthetics but in which there are minor irregularities of individual
teeth

Overjet =   the extent of horizontal overlap of

the maxillary central incisor over the mandibular central incisor Normally the

36
incisors are in contact with upper incisor ahead of lower incisors by only
thickness of upper edges about 2-3 mm

Overbite  = the extent of vertical overlap of the maxillary

central incisor over the mandibular central incisor measured relative to the
incisal ridges. Normally the lower incisor edge in contact the lingual surface
of upper incisors at or above the cingulum plateau and about 2-3 mm

37
38
 5.10. Study Flow Chart

Selection of participants by inclusion criteria

at Department of orthodontics

Explanation of procedure and taking informed consent

Impression taking with 3s intraoral scanner and

Measure the mesiodistal diameter of teeth by using

OrthoAnalyzer software

Data analysis

Comparison of MD
Comparison of width of individual
MD width of MD width of tooth between left
individual tooth individual tooth of and right side of
in male maxillary arch both arches in
between male and males
female Comparison of MD
width of individual
MD width of Comparison of tooth between left
individual tooth MD width of and right side of
in female individual tooth of both arches in
mandibular arch females
between male and
female

39
 5.10. Study flow chart

Selection of participants by inclusion criteria at Department of

orthodontics, University of Dental Medicine, Mandalay

Explanation of procedure and taking informed consent

Impression taking with 3s intraoral scanner

Measure the mesiodistal crown width of individual tooth by using

OrthoAnalyzer software
Data analysis

Mesiodistal crown width of

Mesiodistal crown width of
individual tooth in male
individual tooth in female

Comparison of Mesiodistal crown Comparison of

Mesiodistal Mesiodistal
width crown
of maxillary arch Mesiodistal
crown width of mandibular
between male and crown
width of arch between
female male width of
individual tooth and female individual tooth
between left between left and
and right sides right sides of
of both arches both arches in
in males females

40
41
 6. Ethical Considerations

This study will be carried out after approval of protocol from the
Board of Study (Orthodontics) and the Research and Ethics Committee of
University of Dental Medicine, Mandalay was obtained.

7. Conflict of Interest

There is no potential conflict of interest to be disclosed.

42
8. Results (Dummy Tables)

43
Table 1: Mesiodistal crown width of individual tooth in males

Individual tooth Min width Max width Mean ±SD

(mm) (mm) (mm)
central incisor
lateral incisor
right Canine
first premolar
second premolar
first molar
second molar
central incisor
lateral incisor
left Canine
Maxillary first premolar
second premolar
first molar
second molar
central incisor
lateral incisor
right Canine
first premolar
Mandibular second premolar
first molar
second molar
central incisor
lateral incisor
left Canine
first premolar
second premolar
first molar
second molar

44
Table 2: Mesiodistal crown width of individual tooth in females

Individual tooth Min width Max width Mean ±SD

(mm) (mm) (mm)
central incisor
lateral incisor
right Canine
first premolar
second premolar
first molar
second molar
central incisor
lateral incisor
left Canine
Maxillary first premolar
second premolar
first molar
second molar
central incisor
lateral incisor
right Canine
first premolar
Mandibular second premolar
first molar
second molar
central incisor
lateral incisor
left Canine
first premolar
second premolar
first molar
second molar

45
Table 3: Comparison of the mesiodistal crown width of maxillary teeth between
males and female

Individual Male Female

maxillary p
tooth
Mean SE Mean S.E.
v
±SD Mean ±SD Mean
a
(mm) (mm)
l
u
e

central incisor
lateral incisor
Canine
Right first pre molar
second
premolar
first molar
second molar
Left central incisor
lateral incisor
Canine
first premolar
second
premolar
first molar
second molar
SD, standard deviation; SE, standard error; *p <0.05 significant

46
Table 4: Comparison of mesiodistal crown width of mandibular teeth between
male and female

Individual M Female p value

mandibular ale
tooth
Mean SE Mean S.E.
±SD Mean ±SD Mean
(mm) (mm)
central incisor
lateral incisor
Canine
Righ first premolar
t second
premolar
first molar
second molar
central incisor
lateral incisor
Canine
Left first premolar
Second
premolar
first molar
second molar
SD, standard deviation; SE, standard error; *p<0.05 significant

47
Table 5: Comparison of mesiodistal crown width between right and left sides of
maxillary and mandibular teeth in males

Right (mm) Left(mm)

Arch Individual tooth Mean ±SD Mean ±SD p-value
(n=60) (n=60)
central incisor
lateral incisor
Canine
Maxillary first premolar
second premolar
first molar
second molar
central incisor
lateral incisor
Canine
Mandibula first premolar
r second premolar
first molar
second molar
SD, standard deviation; *p <0.05 significant

48
Table 6: Comparison of mesiodistal crown width between right and left side of
maxillary and mandibular teeth in females

Right (mm) Left(mm)

Arch Individual tooth Mean ±SD Mean ±SD p-value
(n=60) (n=60)
central incisor
lateral incisor
Canine
Maxillary first premolar
second premolar
first molar
second molar
central incisor
lateral incisor
Canine
Mandibula first premolar
r second premolar
first molar
second molar
SD, standard deviation; *p <0.05 significant

49
9.Reference

50
51
10. Plan of Action (Time Activity Schedule)

52
Task 2020 2020 2021 2021 2021
May-Aug Sep-Dec Jan-Apr May-Aug Sep-Dec

Protocol writing and

submission

Case selection and

data collection

Data analysis

Dissertation writing

Dissertation
submission

53
 11. Appendices

Appendix 1. Patient recording form (Proforma)

Identification

Personal data

Date………………………………………… Registration No………………………………

1. Name …………………………………………………

2.Age …………………………………………………

3.Sex …………………………………………………

4.Date of birth …………………………………………………

5.Address …………………………………………………

6.Contact No. …………………………………………………

54
55
11. Appendix 2. Written informed consent (in English)

Informed Consent Form

Name of Principal Investigator Dr. Thet Zaw

Post-graduate Student

Department of Orthodontics

University of Dental Medicine, Mandalay

Name of research

Part A. Patient information

(1) About the study

This research is “A Study of”. Findings from this study will help the treatment
decision for orthodontic patients.
(2) Purpose of the study
The purpose of the present study is to.
(2) Procedure of the study
This study will include taking admitted to Department of Orthodontics,
University of Dental Medicine, Mandalay

(3) Duration of the procedure

Duration of the procedure will be about 20 minutes. Assessment will be done at
Department of Orthodontics, University of Dental Medicine (Mandalay).
(4) Benefits of the study
From this study, value will be helpful in critical decision making for
individualized treatment plan of each patient
(5) Risk of the study

56
 Taking impression taking is a part of routine procedure in orthodontic
treatment.
(6) Incentives
By participating in this study, there will
(8) Confidentiality
The researcher will keep strictly confidential all of your data. Your name will
never be expressed and coding system will be used instead. The information
that we collect from this study will be kept confidential. The knowledge and the
data that we get from doing this study will be disclosed only in the educational
discussion and presentation.
(9) Right to refuse
Your participation in this study is entirely voluntary. It is your choice whether to
participate or not. You have right to refuse for participation in this study and
you are free to withdraw from the research anytime if you wish, and whether
you choose participate or not, all. You may change your mind later stop
participating even if you agreed previously.
(10) Whom to contact
If there is any query, participant can contact to Dr. Thet Zaw, investigator,
Department of Orthodontics, University of Dental Medicine, Mandalay (Tel:
09402667713)
Part B. Certificate of consent
The person who was invited to participate in “A Study of” was noticed that it
has read the foregoing information, or it has been read to the participants. It
was well informed the purpose, procedure, risks and benefits of the research.
There was no personal or individual benefit by participating in this study. It has
been provided with the name of the researcher who can be easily contacted
using the number and address that was given for the participant. The
participant can take part in this study voluntarily. There is the right to withdraw
from the study at any time without in any way affecting my medical care. There
is the opportunity to ask questions about it and any question has been
answered to my satisfaction. The participants also agree to future publications

57
 of study results for medical purpose provided confidentiality is strictly
maintained.
For those who can give informed consent,
Signature of participant Signature of
witness Name --------------------------
--------------------------

NRC NO. ---------------------------

---------------------------

Address ----------------------------
---------------------------

Signature of researcher Name - Dr. Thet Zaw

-----------------------------------------------------------------

Name -Dr.Thet Zaw

Address - Department of Orthodontics,
University of Dental Medicine, Mandalay

Phone No. - 09402667713

Appendix 3. Written informed consent (in Myanmar)

58
59
60