Orthodontics

Lec. 8 Dr. Selma M. Hasan

Space Analysis
Space analysis is a process that allows an estimation of the space required in each arch
to fulfil the treatment aims. It helps to determine whether the treatment aims are
feasible, and assists with the planning of treatment mechanics and anchorage control.
Space planning is carried out in 2 phases:

1- To determine the space required for relief of crowding, overjet correction and
creating space for any planned prostheses.

2- Calculates the amount of space that will be created during treatment by molar
distalization, arch expansion, inter-proximal stripping …etc.

Before undertaking a space analysis, the aims of the treatment should be determined as
this will affect the amount of space required or created. Space analysis can act only as
a guide, as many aspects of orthodontics cannot be accurately predicted, such as
growth, the individual patient’s biological response and patient compliance.

 Space Analysis requires a comparison between the amount of space available for
the alignment of the teeth and the amount of space required to align them properly.

 Space Analysis can be done either directly on the dental casts or by a computer
method after appropriate digitization of the arch and tooth dimensions.

 Crowding in the arch is denoted as a negative number (-) while excess spacing in
the archis denoted as a positive number ().

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Lec. 8 Dr. Selma M. Hasan
MIXED DENTITION ANALYSIS:
In mixed dentition space analysis, mesiodistal width of unerupted canine and premolars
is predicted so that discrepancy between space available and space required for these
teeth in the dental arch can be determined. There are three main approaches to mixed
dentition space analysis:
a) Measurement from radiographs:
The widths of unerupted canine and premolars is estimated using proportionate
measurement from radiographs, which takes into account any magnification. The
widths of permanent canine and premolars are measured directly from dental
radiographs. The width of a deciduous molar is measured from the radiograph and from
the dental cast and the following equation is used:

𝑻𝒓𝒖𝒆 𝒘𝒊𝒅𝒕𝒉 𝒐𝒇 𝒑𝒓𝒊𝒎𝒂𝒓𝒚 𝒎𝒐𝒍𝒂𝒓 𝑻𝒓𝒖𝒆 𝒘𝒊𝒅𝒕𝒉 𝒐𝒇 𝒖𝒏𝒆𝒓𝒖𝒑𝒕𝒆𝒅 𝒑𝒓𝒆𝒎𝒐𝒍𝒂𝒓

=
𝑨𝒑𝒑𝒂𝒓𝒆𝒏𝒕 𝒘𝒊𝒅𝒕𝒉 𝒐𝒇 𝒑𝒓𝒊𝒎𝒂𝒓𝒚 𝒎𝒐𝒍𝒂𝒓 𝑨𝒑𝒑𝒂𝒓𝒆𝒏𝒕 𝒘𝒊𝒅𝒕𝒉 𝒐𝒇 𝒖𝒏𝒆𝒓𝒖𝒑𝒕𝒆𝒅 𝒑𝒓𝒆𝒎𝒐𝒍𝒂𝒓

Then the combined widths of the permanent canine and premolars is compared to the
combined widths of the deciduous canine and molars.

b) Prediction tables or equation:

They are based on the direct measurement of the mesiodistal width of already erupted
permanent teeth especially mandibular incisors to estimate the size of unerupted canine
and premolars. The most commonly used are Moyer’s Mixed Dentition Analysis and
Tanaka and Johnson Analysis. They predict the combined widths of the unerupted
canines and premolars from the widths of the mandibular incisors. The mandibular
incisors were chosen because of their early eruption. The maxillary incisors are not
used since they show a lot variability in size.

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Lec. 8 Dr. Selma M. Hasan
Moyers Mixed Dentition Analysis: The greatest mesiodistal width of each of the four
mandibular incisors is measured from a cast and summed up. Then the combined
widths of the unerupted canines and premolars are predicted by use of probability
charts. In the tables, 75% level of probability is used as it is the most practical from a
clinical standpoint.
Remember that the width of the lower incisors is used to predict upper canine and
premolars widths too.
Moyers Prediction Values (75% level)
Total mandibular-incisor width 19.5 20.0 20.5 21.0 21.5 22.0 22.5 23.0
Predicted width of Maxilla 20.6 20.9 21.2 21.3 21.8 22.0 22.3 22.6
canine and premolars
Mandible 20.1 20.4 20.7 21.0 21.3 21.6 21.9 22.2

Tanaka and Johnson Analysis: They simplified Moyers 75% level of prediction table
into a formula to predicted the width of maxillary canine and premolars (in one
quadrant):
𝑈𝑝𝑝𝑒𝑟 𝑐𝑎𝑛𝑖𝑛𝑒 & 𝑝𝑟𝑒𝑚𝑜𝑙𝑎𝑟𝑠 𝑤𝑖𝑑𝑡ℎ𝑠 = 𝑤𝑖𝑑𝑡ℎ 𝑜𝑓 𝑓𝑜𝑢𝑟 𝑙𝑜𝑤𝑒𝑟 𝑖𝑛𝑐𝑖𝑠𝑜𝑟𝑠 /2 + 11𝑚𝑚
𝐿𝑜𝑤𝑒𝑟 𝑐𝑎𝑛𝑖𝑛𝑒 & 𝑝𝑟𝑒𝑚𝑜𝑙𝑎𝑟𝑠 𝑤𝑖𝑑𝑡ℎ𝑠 = 𝑤𝑖𝑑𝑡ℎ 𝑜𝑓 𝑓𝑜𝑢𝑟 𝑙𝑜𝑤𝑒𝑟 𝑖𝑛𝑐𝑖𝑠𝑜𝑟𝑠 /2 + 10.5𝑚

c) Combination of radiograph and prediction equation: This is done by using direct

measurement of the mandibular incisors and proportionate measurement of the
premolars and canine from radiographs. After predicting the width of the unerupted
canine and premolars:
1- Determine the amount of space needed for alignment of the incisors.
2- Measure the amount of space available of canine and premolars from the mesial
surface of the first permanent molar to the distal surface of the lateral incisor.
3- Subtract the space needed for incisor alignment, any necessary molar adjustment
and overjet correction. This is the actual space available.
4- Finally compare the space available with the predicted canine and premolar widths
to estimate space need.
This will help to decide on the use of space regainers or space maintainers.
a) Space need of 2mm per quadrant can be treated by lingual or palatal arch to preserve
Leeway space giving room for eruption of the permanent premolars and canines and
proper alignment of incisors.
b) Space need of 3mm per quadrant should be referred to the orthodontist to plan for
space creation during the mixed dentition or later during comprehensive orthodontic
treatment.
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 Orthodontics
Lec. 8 Dr. Selma M. Hasan
PERMANENT DENTITION ANALYSIS:
The aim of space analysis is to determine the space
and anchorage requirements for orthodontic
treatment. Commonly Used Methods
1- Visualization is the most commonly used method
but is inaccurate in quantifying crowding.
2- The amount of crowding can be calculated by
measuring the mesiodistal width of any misaligned
tooth in relation to the available space in the arch.
This process is repeated for all the misaligned teeth in
the arch to give the total extent of crowding.

3- Arch perimeter/ Carey’s Analysis: the mesiodistal widths of the incisors, canines
and premolars are measured by a divider and the sum represents the space needed. A
soft brass wire is passed from the mesial surface of the first molar to the contra-lateral
side. The wire passes along the buccal cusps of premolars and incisal edges of the
anteriors. In crowded arches, the wire should be pass according to the arch form that
reflects the majority of the teeth. The wire should pass along the cingula of anterior
teeth if they are proclined and along their labial surfaces if they are retroclined. The
wire is then straightened to measure the space available. The difference is the space
need or excess.

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Lec. 8 Dr. Selma M. Hasan
4- Segmental arch analysis: The same as Carey’s
Analysis but done in three segments; from the mesial
of the first molars to the mesial of the canines for the
distal segments and between the mesial of the canines
for the anterior segment.

5- Digital 3D scanning: Many software programs are equipped with a facility to plot
contact points in order to identify the arch form, as well as a ‘virtual ruler’ that can
measure mesiodistal tooth widths.

Malocclusion Features to Consider in Space Analysis:

1) Crowding and spacing: Crowding and spacing should be measured mesial to the
first permanent molars in relationship to the archform that fits the majority of teeth.
The mesiodistal width of the malaligned teeth is measured followed by the available
space within the archform. Crowding can be quantified as mild (<4 mm), moderate
(4–8 mm) or severe (≥8 mm).
If the second deciduous molars are retained, approximately 1 mm of space per quadrant
will be available following exfoliation and eruption of second premolars in the upper
arch and 2 mm in each quadrant in the lower arch.
2) Incisor anteroposterior movement: With few exceptions, the lower incisor
anteroposterior (AP) position should be accepted to maximize stability. In Class II
malocclusions, the upper incisors must be retracted for overjet reduction. Conversely,

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Lec. 8 Dr. Selma M. Hasan
in Class III malocclusions the upper incisors may be advanced and the lowers retracted
to correct a reverse overjet. For every 1 mm all four incisors are retracted, 2 mm of
space (1 mm per quadrant) is required. Conversely, for every 1 mm all four incisors
are advanced, 2 mm of space will be created.

3) Correction of upper incisor angulation and inclination:

Changing the inclination (torque) of incisors has
space implications. When the upper incisors are
proclined, the overjet increases and space is required
to normalise this increase. When proclined incisors
are retroclined, every 5° of retroclination will reduce
the overjet by 0.5mm and requires 1mm of space.
The space requirement to correct incisor angulation
(mesiodistal tip) is usually minimal.
4) Levelling the curve of Spee: Where there is no
occlusal stop the lower incisors may over-erupt
resulting in an occlusal curve which runs from the
molars to the incisors (Curve of Spee). Levelling
an increased curve of Spee requires 1 to 2mm of
space depending on the depth of the curve, which
is measured from the premolar cusps to a flat plane
joining the distal cusps of first permanent molars
and incisors. Flattening deep curves of Spee
increasing arch length and labially proclines the
incisor teeth.

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Lec. 8 Dr. Selma M. Hasan
5) Arch contraction and expansion: Upper arch lateral expansion is undertaken for
posterior crossbite correction and is useful in providing space for the relief of crowding
and/or overjet reduction. Every 1 mm of lateral expansion creates approximately 0.5
mm of space within the arch. While, arch contraction requires space.
6) Tooth reshaping or replacement: Mesiodistal enlargement of microdont teeth and
replacement of missing teeth require space. Also, extremely large teeth need to be
stripped to normal size. This needs to be taken into account when determining total
arch space requirements. Once all of the above factors have been considered, it is
possible to calculate the space required within each arch.

Space availablespace requiredSpace analysis

In CL  it is important to include the amount of over jet (O.J.) in space

analysis.

(O.J.  2)  2  crowding  Space analysis

(O.J.  2)  2  spacing  Space analysis

Leeway Space
The combined mesiodistal widths of deciduous canine, first and second molars is more
than that of the combined mesiodistal widths of permanent canine, first and second
premolars. The difference between the two is called Leeway Space.
Maxilla  0.9 mm / segment  1.8 mm total
Mandible  1.7 mm /segment  3.4 mm total
If space analysis is done in the mixed dentition, it is necessary to adjust the space
available measurement to reflect the shift in molar position that can be anticipated.

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 Orthodontics
Lec. 8 Dr. Selma M. Hasan
Calculating Space Requirement:

A patient has:

 6mm overjet

 3mm curve of Spee in the lower arch

 2mm upper arch crowding

 2mm lower arch spacing

 requires upper arch expansion of 4mm

 requires 2mm stripping of his large upper central incisors Calculate the space
requirement.

 The overjet is increased by 4mm (6 – 2 = 4mm). To reduce overjet to normal

8mm of space is required (4 x 2 = 8mm, 4mm of each side).

 Leveling a 3mm deep curve of Spee requires 1mm of space.

 4mm of expansion creates 2mm of space within the upper arch.

Lower arch Upper arch

Crowding / spacing +2 m -2 mm Incisor

AP movement +8 mm

Incisor inclination

Levelling the curve of Spee +1 mm

Arch contraction / expansion -2 mm

Tooth enlargement / replacement -2 mm

Total + 6 mm -1 mm

A negative score shows a space gain; a positive score shows space requirement.
The patient has 6mm space need in the upper arch and 1mm extra space in the
lower arch.