Model Analysis

Presented by: Nikhil V Jose

Dept. of Orthodontics

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 Contents
• Introduction
• Definition
• Fabrication of Study model
• Uses of study model
• Model analysis
1) Permanent Dentition
2) Mixed Dentition
• Recent advancements
• Conclusion

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 Introduction
• Success in orthodontic treatment – Diagnosis.
• Many diagnostic aids are available today but study models are
oldest.
• Model analysis is an adjunct in diagnosis and treatment
planning. It should hence be correlated with the other data in
the diagnosis before formulating any treatment plan .

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 Clinical
Examination

Functional Analysis
Case History

Comprehensive diagnosis
Roentgeno-
Cephalo-
Study Cast MetricAna-
Analysis lysis

Photographic
Radiographic Analysis
Examination

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5
 Definition
• Model analysis is the study of
maxillary and mandibular
dental arches in all the three
planes of spaces using study
models and radiographs which
is a valuable tool in
orthodontic diagnosis and
treatment planning.

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Study Model Fabrication

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 PARTS OF THE STUDY MODELS
• Study models can be divided into two
parts:

• The anatomic portion.

• The artistic portion.

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 OBJECTIVES OF IDEAL ORTHODONTIC STUDY
MODELS
• Models accurately reproduce the teeth and their
surrounding soft tissues.
• Models are to be trimmed so that they are
symmetrical and also the asymmetrical arch form can
be readily recognized.
• Models should trimmed so to meet the proposed
ideal measurement.

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• Models are to be trimmed in such a way that the occlusion
shows by setting the models on their backs.
• Models are to have clean, smooth, bubble free surfaces
with sharp angles where the cuts meet.
• The finished models will be treated with a soap solution to
give a glassy mar-proof finish.

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 USES OF STUDY MODELS
• They enable the study of occlusion from all aspects.
• They enable accurate measurements to be made in a dental
arch.
• They help in assessment of the treatment progress.
• They help in motivation of the patient and to explain the
treatment plan.

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• It makes possible to simulate treatment
procedures on the cast such as mock surgery.
• Study models are useful to transfer records in case
the patient is to be treated by another clinician.
• Study models helps to determine the midline
discrepancy.
• It also helps in assessment of surrounding tissue.

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TOOTH SIZE-ARCH WIDTH DISCREPANCY

• PONT’S ANALYSIS.
• LINDERHARTH ANALYSIS
• KORKHAUS ANALYSIS
• ASLEY–HOWE ANALYSIS

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TOOTH SIZE-ARCH LENGTH DISCREPENCY
• ARCH-PERIMETER ANALYSIS
• NANCE-CAREY’S ANALYSIS
• IRREGULAR INDEX
• REE’S ANALYSIS.
• DIAGNOSTIC SET UP
• LAARRY WHITE ANALYSIS
• SANIN & SAVARA ANALYSIS
• TOTAL SPACE ANALYSIS
• TWEED METHOD

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 MIXED- DENTION ANALYSIS
(Estimating the size of unerupted teeth)
 MOYER’S ANALYSIS.
 TANAKA-JOHNSTON ANALYSIS.
 HIXON-OLD FATHER METHOD.
 HUCKABA ANALYSIS.

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UPPER/LOWER TOOTH SIZE DISHARMONY

 BOLTON’S TOOTH RATIO ANALYSIS

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TOOTH-SHAPE DISHARMONY
 PECK & PECK INDEX.

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PHOTOGRAPHIC ANALYSIS OF STUDY
MODEL
• STEROPHOTOGRAMETRY
• OCCLUSOGRAMS
• HOLOGRAPHIC IMAGE ANALYSIS

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COMPUTERIZED ANALYSIS
• OSCOPO
• REFLEX METROGRAPHY

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 Armamentarium
• a) Divider
• b) Ruler
• c) Wedge Ruler
• d) Vernier Caliper
• e) Brass Wire

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 Measurements Required
 Tooth Measurements  Other measurements
a) Sum of 2 to 2
a) Centrals b) Tooth material
b) Laterals ( Sum of 5 to 5 )
c) Canines
c) Total Tooth Material
d) First Premolars
e) Second Premolars ( Sum of 6 to 6 )
f) First Molar d) Arch Width
e) Arch Perimeter
f) PMD
g) PMBAW etc.

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 Pont’s Analysis
• In 1909, Pont devised a method of predetermining an “ideal”
arch width based on the mesio-distal widths of the crowns of
the maxillary incisors.
• Pont suggested that the ratio of combined incisor to arch width
( as measured from the center of the occlusal surface of the
teeth) was ideally 0.8 in the bicuspid area and 0.64 in the first
molar area.

A clinical evaluation. Angle, Orthod ; 1970.

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• Pont also suggested that the maxillary arch be
expanded 1 to 2mm more during treatment than
his ideal to allow for relapse.
• Pont’s analysis helps in,
a) Determining whether dental arch is narrow or is
normal.
b) Determining the need for lateral arch expansion.
c) Determining how much expansion is possible at the
premolar and molar regions.

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• Determination of sum of
incisors (S.I)

• Determination of measured
premolar value (M.P.V)

• Determination of measured
molar value (M.M.V)

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• Determination of
calculated premolar value
(C.P.V)

• Determination of
calculated molar value
(C.M.V)

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 Inference
• If measured value is less than the calculated value, then
arch is narrow for the sum incisors width and needs
expansion.
• If measured value is greater than the calculated value,
then the arch is wider and there is no scope for the
expansion.

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 Drawbacks
• Analysis is based on study of French population and
hence, its universal validity is questionable.
• Maxillary laterals are the most commonly missing and
malformed teeth (i,e Peg shaped).
• Does not consider skeletal mal-relationships and
relationship of teeth to the supporting bone.

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• Mandibular arch form and mandibular intercanine
diameter have been repeatedly found to be more
reasonable treatment guides for both maxillary and
mandibular ultimate arch widths than the pont’s index.
• Pont’s index is naive in concept and of little use in
rational treatment planning.

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 Linder Harth analysis
• Similar to Pont’s analysis.
 A variation has been proposed to determine the
calculated premolar value and calculated molar value.

 Calculated premolar value : S.I X 100

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 Calculated molar value : S.I X 100
64

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 Korkhaus Analysis
 This analysis is similar to Pont’s analysis.
 Korkhaus uses Linder Harth’s measurements.
 An orthometer was devised by Korkhaus and from
that ideal arch width in premolar region and molar
region can be determined.
 The perpendicular distance from the inter-premolar
line to the incision for a given S.I can be determined.

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 Introduces a third measurement from the midpoint
of inter- premolar line of upper arch to a point in
between the two maxillary incisors.

Measurements.
a) Arch width in premolar
region & b) in molar Region.
c) Perpendicular distance from
the midpoint of inter premolar
line to incision.

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 For a particular width of incisors there is a specific
value of distance from the incision to the inter
premolar line according to Korkhaus.
 Inference :
a) This analysis tells about the arch width.
b) If the perpendicular distance is more
than ideal, then anterior teeth are
proclined.
c) If the perpendicular distance is less than
the ideal, then the anterior teeth are
retroclined.
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Korkhaus Measurements.
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• For the values noted the
mandibular value (Ll)
should be equal to the
maxillary value (Lu) in
millimeters minus 2mm.

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 Arch perimeter Analysis
• Many malocclusions are as a result of discrepancy between arch
length and tooth material.
• This analysis helps us to find the difference between the basal
bone and the tooth material i,e in determining the extent of
Discrepancy.
• The same analysis is called “Carey’s Analysis” in the lower cast.

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• Determination of arch
length.
Arch length anterior to
the first permanent
molar is measured using
a soft brass wire.

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• In case of proclined anteriors, the wire is passed
along the cingulum of anterior teeth.
• If the anterior teeth are retroclined, the brass
wire is passed labial to the teeth.
• If the anterior teeth are well aligned, the wire is
passed over the incisal edges of the anterior
teeth.

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• Determination of tooth
material.
The mesio-distal width of
the teeth anterior to the
first molars (second
premolars to second
premolars) is measured
and summed up.

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• Determination of the Discrepancy.
The discrepancy refers to the difference between the
arch length and tooth material.
 Inference.

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 Drawbacks

• This procedure of accessing arch length does not appear

to be clear-cut in border line cases.
• The visualized form will vary with the individual who is
contouring the wire.

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 Peck and Peck Index
• Tooth shape (mesio distal and faciolingual) is determining
factor in the presence and absence of lower incisor
crowding.
• Harvey peck and Sheldon Peck present a new method of
detecting and evaluating tooth shape deviations of the
mandibular incisors.

Index for assessing tooth shape deviations.

Am. J. Orthod April 1972

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• Orthodontic Odontometry.
• Crown dimensions more frequently reported are the
mesio distal diameter.
• No curently used clinical analysis employs or even
takes into consideration the facio lingual tooth
dimension.
• Both MD and FL dimensions appear to be related to
incisor alignment.
• This index incorporates both dimensions for
orthodontic tooth size analysis.

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• According to Peck and Peck, persons with ideal incisal
arrangement had smaller mesiodistal width and comparatively
larger faciolingual width than in persons with incisal crowding.
• On the basis of this observation, Peck and Peck suggested
certain clinical guidelines.

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 Index = M.D X 100
F.L/L.L
 MD/FL index as a
numerical expression of
crown shape as viewed
incisally is confined to
the mandibular incisors.

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45
• Mean value for lower central incisor should be 88% to
92%.
• Mean value for lower lateral incisor should be 90% to
95%.
• Inference :
a) Lower incisors within or below these
ranges are considered favorably
shaped.
b) Lower incisors with MD/FL index above
these ranges considered to have crown
shape deviations contributing to
crowding phenomenon. 46
47
• The reference table provides the computed value of
the MD/FL index, given the MD and FL crown
dimensions.
• Example: Mandibular right lateral incisor having
MD=6.0 and FL=6.3, will have MD/FL index of 95.
• In a given case if the value is more, then authors
recommend Proximal stripping or Tooth
Reproximation.

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• Reproximation: Tooth reproximation is a clinical
procedure involving the reduction, anatomic
recontouring, and protection of the mesial and/or
distal enamel surfaces of a permanent tooth.
• A consideration of tooth shape and the MD/FL index
appears essential for the successful orthodontic
management of the incisor irregularities.

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 Sanin and Savara Analysis
• Mesio distal crown-size relationships are decisive
variables in the search for,
a) Factors associated with the development of occlusal
and facial irregularities.
b) The possible effects of discrepancies upon
interdigitation during after orthodontic treatment,
c) The isolation of discrepant teeth of minor tooth
malocclusions that may be treated in part by selective
mesio distal grinding and minor tooth movement.

An analysis of permanent mesio distal crown size.

[Link] (59) 1971.

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• There is a direct relationship between the magnitude
of the crown-size differences( regardless of the
number of teeth involved) and the presence of
occlusal irregularities.
• There is also a direct relationship between number
of discrepant teeth( regardless of the magnitude of
the crown size differences) and the presence of
occlusal irregularities.

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• The purpose of their study was to examine the
possibility of using a norm of mesio distal size of the
permanent teeth for locating and analyzing crown-
size discrepancies.
• The analysis proposed would contribute to a more
complete evaluation of intra-oral etiologic factors
and a more precise diagnosis and prognosis of the
dental problem.

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Mesio distal crown sizes of 51 boys and 50 girls of north west European ancestry
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selected from the university of Oregon dental school.
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• Some of the characteristics that may be studied with
the assistance of the tables are,
a) The size of the maxillary teeth as a whole relative to
the size of the mandibular teeth as a whole,
b) The size of the individual teeth or groups of teeth
relative to individual teeth or groups of antagonist
teeth, and
c) Discrepancies between right and left sides and, in all
cases, the direction of the discrepancy if present( small,
average or large) and their magnitude.

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• This analysis presents an effective way of locating and
analyzing crown-size discrepancies.
• Crown size patterns differ greatly, even among good
occlusions.
• The complexity of interdigitation in orthodontic treatment
is emphasized.

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 Ashley Howe’s Analysis
• Ashley Howe considered tooth crowding to be due to
deficiency in arch width rather than arch length.
• He found a relationship between total width of 12 teeth
anterior to the second molars and the width of the dental
arch in the first premolar region.

A Polygon Portrayal of coronal and basal arch dimensions

in the horizontal plane. Am. J. Orthod. Nov,1954.

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Howe’s analysis measurements.

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• Determination of total
tooth material.
The mesio distal width of
all the teeth mesial to the
second permanent molars
is measured with the help
of dividers and the values
are summed up. This
value is called Total Tooth
material (TTM).

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• Determination of first
bicuspid coronal arch
width.( BIC.W)
This measurement is the
distance between the
summits of the buccal
cusps of the first
bicuspids.

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• Determination of basal
arch width( B.A.W) above
the maxillary first
bicuspids and below of
mandibular first
bicuspids.
• Basal arch width will be
greater than the coronal
arch.

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• The canine fossa is found diatal to the canine
eminence. The measurement of the width from
canine fossa of one side to the canine fossa of other
gives the premolar basal arch width ( P.M.B.A.W).
• If the canine fossa is not clearly distinguishable then
the measurement is made from a point 8mm below
the crest of inter dental papilla distal to the canine.

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• The percentage
relationship of first
bicuspid width to tooth
material.
BIC.W = % TTM
 The percentage
relationship of first
bicuspid basal arch width
to tooth material.
B.A.W = %
TTM

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• Determination of Basal
arch length.( B.A.L)
In the maxilla the median
line measurement from
Downs A point
perpendicular to the
occlusal plane , then to
the median point on a
line connecting the distal
surface of the first molar.

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• In the mandibular arch the
measurement is made from downs
B point to a mark on the lingual
surface of cast as was incase of the
maxilla.

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• Determination of the percentage of arch length to the
tooth material.
B.A.L = %
TTM
 The percentage relationship is more important than the
actual measurement.

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 Inference
• Howe’s believed that the premolar basal arch width
( B.A.W) which he called as the canine fossa
diameter should equal approximately 44% of the
mesio distal widths of the 12 teeth in the maxilla, if it
is to be sufficiently large enough to accommodate all
the teeth.
• When the ratio is less than 37%, he considered this
to be a basal arch deficiency necessitating extraction
of premolars.

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• If the premolar basal arch width is
greater than the premolar coronal
arch width (B.A.W>BIC.W),
expansion of the premolars may be
undertaken safely.

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 Advantages
• Howe’s analysis is useful in treatment planning of
problems with suspected apical base deficiencies
and deciding to whether to,
1) Extract teeth,
2) Widen the dental arch, or
3) Expand rapidly the palate.

 Howe’s analysis is applicable to each arch.

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 Wayne A. Bolton Analysis
• Bolton pointed out that the extraction of one tooth
or several teeth should be done according to the
ratio of tooth material between the maxillary and
mandibular arch, to get ideal interdigitation, overjet,
overbite and alignment of teeth.
• Bolton’s analysis helps to determine the
disproportion between the sizes of the maxillary and
the mandibular teeth.

Disharmony in tooth size and its relation to the analysis and

treatment of malocclusion. Angle orthod (28) 1958.

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• To attain an optimum inter- arch dental relationship, the
maxillary tooth material should approximate desirable
ratios, as compared to the mandibular tooth material.
• Average proportion between upper and lower teeth in
overall and anterior region helps to create a normal overjet
and overbite.

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 Measurements
• Sum of mandibular 12.
• Sum of maxillary 12.
• Sum of mandibular 6.
• Sum of maxillary 6.
• Overall Ratio.
• Anterior Ratio.

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• Determination of overall Ratio.

According to Bolton, the sum of mesio distal widths of

the mandibular teeth anterior to the second
permanent molar is 91.3% the mesio distal widths
of the maxillary teeth mesial to the second molars.
Overall Ratio = Sum of mandibular 12 X 100
Sum of maxillary 12
1) If ratio is less than 91.3%, maxillary tooth material
excess.
2) If ratio is more than 91.3%, Mandibular tooth
material excess.

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• Determination of anterior ratio.
The sum of mesio distal width of the mandibular
anteriors to the mesio distal width of the maxillary
anteriors should be 77.2%.
Anterior Ratio = Sum of mandibular 6 X 100
Sum of maxillary 6
1) If ratio is less than 77.2%, maxillary anterior excess.
2) If ratio is more than 77.2%, Mandibular anterior
excess.

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75
 Advantage & Disadvantages
• When contemplating the extraction of four
premolars, it is useful, before selecting the teeth for
extraction, to ascertain the effects of various
extraction combinations on these ratios.
• Study done on specific population.
• Does not take into account the sexual dimorphism in
the maxillary canine widths.

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 Irregular Index
• Given by Robert M. Little.
• Anterior dental crowding is perhaps the most frequently
occurring characteristics of malocclusion.
• Adjectives such as mild, moderate and severe etc. are
descriptively helpful but still allow a wide range of
interpretation.

The irregularity index ; A quantitative score of mandibular anterior

alignment. AJO, Vol. 68 : 1975.

77
 Method
• The proposed scoring method involves measuring
the linear displacement of anatomic contact points,
of each mandibular incisors from the adjacent tooth
anatomic points.
• The sum of these five displacements represent the
degree of anterior irregularity.

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• Each of five measurements
represents, in horizontal
linear distance between
the vertical projection of
the anatomic contact
points of adjacent teeth.

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 Calculations/ Inference
• The results of the irregularity index can be correlated with
the scale ranging from 0 to 10 formed by the subjective
ranking.
• 0 – Perfect Alignment.
• 1,2,3 - Minimum irregularity.
• 4,5,6 - Moderate irregularity.
• 7,8,9 – Severe irregularity.
• 10 to 20 – Very severe irregularity.

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 Rees Analysis
• Given by Denton J. Rees.
• All the measurements are made on study models
which should be essentially accurate.
• Special attention given to the extension into the
mucobuccal fold in order to approximate basal bone
to at least the distal of first permanent molar.

A method of assessing the proportional relation of apical bases & contact

diameters of teeth. AJO, VOL: 39: 1953.

81
 Method
• A ruler is placed against the side
of the cast, at right angles to the
occlusal surface, and a line is
drawn at the mesial contact point
of each first permanent molar.
• The third line is drawn through
the midline contact of upper and
lower central incisor.
• This line is extended to a point 8-
10mm from the gingival margin
in the apical direction.

82
• A piece of scotch tape 5 inches long is cut into strips
approximately 1/8th inch wide and a thin strip of tape is then
placed so that one end is superimposed on the molar mark.
• The tape is pressed firmly to the cast to pass through the incisor
point, and then trough the opposite molar point.
• The teeth on each cast from second premolar to second premolar
are recorded at their greatest mesio distal diameter.

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 Calculations
• Following chart permits a quick analysis on any sets of
casts.
UB to UT =1.5 to 5 - mean 3.5 - range 3.5
LB to LT =2 to 7 - mean 4.5 - range 5
UB to LB =3 to 9.5 - mean 6.5 - range 6.5
UT to LT =5 to 10 - mean 7.5 - range 5

Where U = MAXILLA; L= MANDIBLE;

B= APICAL BASE; T= TOOTH CROWN

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 Inference
• By comparing the average normals to the measurements
taken on the set up casts, following points of diagnostic
importance can be derived.
1) UB to UT or LB to LT.
If discrepancy exists, in borderline cases, internal and
external muscular forces, facial esthetics, and other
factors will determine the treatment plan.

85
2) UB to LB.
If discrepancy exists, reduction of teeth and base
may be necessary in one arch, or if not indicated,
expansion of other arch is the only alternative.
3) UT to LT.
If discrepancy beyond normal range are present,
tooth mass is reduced in one arch or increased in
the other by judicious placement of crown or inlays.

86
 Diagnostic Set up
• HD Kesling introduced the diagnostic set up which is
made from an extra set of trimmed study models.
• Also called as Prognostic Set Up, as it helps to
ascertain precisely the amount and direction of each
tooth to be moved.
• For visualizing space problems in three dimensions in
the permanent dentition, the teeth are cut off from
the cast and reset in a more desirable position.

The Diagnostic Set-up with consideration of third dimension

Am. J. Orhtod, 42 ; 740-748, 1956
87
 Steps
• Obtain an accurate wax
bite. Trim posterior
portion of the bases of
the casts with the wax
bite interposed so that
the bases are flush.
• Drill a whole trough the
alveolar portion of the
cast well below the
gingival margin of the
teeth.

88
• Insert a fine saw blade through
the hole and cut up to the
crest of the gingival margin
between two of the teeth.
• Cut along the line of the arch,
well beneath the gingival
margin of the teeth, and come
up again at the point of the
gingival crest below the
contact point on the opposite
side of the tooth.

89
• Repeat this for all
the teeth to be cut
off the cast. Do not
cut through the
contact points.
Cutting up to the
gingival crest will
permit gentle
breaking of plaster
without damage.
• Align the teeth and
wax them into the
90
desired positions.
• It is best not to cut off all the teeth so that the bite
relationship can be kept.
• A more accurate method involves taking a wax bite in
the retruded contact position, mounting the casts on
the adjustable articulator, and finishing the
diagnostic set up within the limits of the jaw
relationships thus imposed.
• One may combine the cephalometric analysis and
prediction of incisal positioning and angulations with
the prognostic set up.
91
 Uses
• Aids in treatment planning as it helps to visualize tooth size
arch length discrepancies and determine whether
extraction is required or not.
• The effect of extraction and tooth movement following it
on occlusion can be visualized.
• It also acts as a motivational tool as the improvements in
tooth positions can be shown to the patient.

92
 Space Analysis
• To quantify the amount of crowding within the
arches.
• Because treatment varies depending on the
severity of the crowding.
• Principle : Since malaligned and crowded teeth
usually result from lack of space, this analysis is
primarily of space within the arches.

93
• It requires a comparison between the amount of
space available for the alignment of crowded
teeth and amount of space required to align them
properly.
• Analysis can be done either directly on the dental
casts or computer after appropriate digitization of
the arch and tooth dimensions.

94
 Method
• Space available
• Accomplished by measuring
arch perimeter from first
molar to the other, over the
contact points of posterior
teeth and incisal edges of
anteriors.
• There are two basic ways:
1. By dividing the dental arch
into segments that can be
measured as straight line
approximations of the arch.

95
2. By contouring piece of wire to the
line of occlusion and then
straightening it out for
measurement.
 The first method is preferred for
manual calculation because of its
greatest reliabilty.

96
• Space Required
• Done by measuring the
mesiodistal width of each
tooth from contact point
to point, and then
summing the widths of
individual teeth.

97
 Inference
• If the sum of widths of the permanent teeth is
greater than the amount of available space, there is
an arch perimeter space deficiency and crowding
would occur.
• If space available is larger than the space required
(excess space), gaps between some teeth would be
expected.

98
• Space analysis carried out in this way is based on
two important assumptions:
1. The anteroposterior position of the incisors is
correct ( i,e the incisors are neither excessively
protrusive nor retrusive), and
2. The space available will not change because of
growth.
 Neither assumptions can be taken for granted.

99
 References
 ORTHODONTICS
PRINCIPLES AND PRACTICE,
- GRABER T.M.
• Handbook of orthodontics.
- ROBERT E. MOYERS.
• Contemporary orthodontics.
- WILLIAM R. PROFFIT.
• Orthodontics
current principles and concepts.
- THOMAS M. GRABER & Vanarsdall

100
• Index for assessing toothe shape deviations.
Am. J. Orthod April 1972.
 A method of assessing the proportional relation of
apical bases & contact diameters of teeth. AJO, VOL:
39: 1953.
 Accurate arch – Discrepancy measurements. AJO,
Vol. 72: 1977.
 The irregularity index ; A quantitative score of
mandibular anterior alignment. AJO, Vol. 68 : 1975.
101
 Disharmony in tooth size and its relation to the
analysis and treatment of malocclusion. Angle orthod
(28) 1958.
• A Polygon Portrayal of coronal and basal arch
dimension
in the horizontal plane. Am. J. Orthod. Nov,1954.
• An analysis of permanent mesio distal crown size.
[Link] (59) 1971.

102
• END OF PART 1

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