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Original Article
Bolton tooth size ratio among qatari population sample:
An odontometric study
Hayder A Hashim, Najah ALSayed and Hashim ALHussain

Objectives: To establish the overall and anterior Bolton ratio among a sample of Qatari population
and to investigate whether there is a difference between males and females, as well as to compare
the result obtained by Bolton.
Materials and Methods: The current study consisted of 100 orthodontic study participants(50males
and 50females) with different malocclusions and age ranging between 15 and 20years. An electronic
digital caliper was used to measure the mesiodistal tooth width of all maxillary and mandibular
permanent teeth except second and third molars. The Students ttest was used to compare toothsize
ratios between males and females and between the results of the present study and Boltons result.
Results: The anterior and overall ratio in Qatari individuals were 78.63.4 and 91.83.1,
respectively. The tooth size ratios were slightly greater in males than that in females, however, the
differences were not statistically significant(P>0.05). There were no significant differences in the
overall ratio between Qatari individuals and Boltons results(P>0.05), whereas statistical significant
differences were observed in anterior ratio(P=0.007).
Conclusions: Within the limitation of the limitations of the present study, definite conclusion was
difficult to establish. Thus, a further study with a large sample in each malocclusion group is required.

Key words: Anterior ratio, Bolton ratio, malocclusion, overall ratio

INTRODUCTION Several investigators when measuring the tooth width follow

the contact method using either a pair of dividers with millimeter
Teeth are arranged in harmony with each other and with other ruler[25] or sliding calipers.[6,7] On the other hand, noncontact
structures in the face and the mouth, including the muscles methods include prints of the dental cast.[8] Television images[9]
of mastication, the tongue, and the bones of maxilla and and photographs of dental casts have also been used, and can
mandible. The presence of deciduous and permanent dentition be considered a reliable and efficient source of data. Further,
is important in mastication as well as in esthetics. Patients laser holograms of occlusal surfaces have also been used for
attending orthodontic clinics normally complain of either tooth width measurement.[10,11] Furthermore, threedimensional
crowding or spacing or both, which represents a big esthetic analysis of dental casts can also be obtained and used by
and functional problem.[1] means of stereophotogrammetry[12] and Optocom.[13]

Hamad Medical Corporation, Rumaila Hospital, Dental In orthodontics, dental casts are still considered as a
Centre, Orthodontic Division, Doha, Qatar fundamental diagnostic tool.[14] From the dental cast, one can
Address for correspondence: Dr. Hayder Abdalla Hashim, analyze tooth size, shape, alignment, rotations of the teeth,
Hamad Medical Corporation, Rumaila Hospital, Dental Centre, presence or absence of teeth, arch form and symmetry, and
Orthodontic Division, P.O. Box 3050, Doha, Qatar. occlusal relationship.[15]

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DOI: How to cite this article: Hashim HA, AL-Sayed N,

10.4103/2278-0203.197395 AL-Hussain H. Bolton tooth size ratio among qatari population
sample: An odontometric study. J Orthodont Sci 2017;6:22-7.

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Hashim, etal.: Bolton tooth ratio

The importance of having a certain relationship between the Saatci and Yukay[14] investigated the role of different type of
maxillary and mandibular teeth has attracted the attention of tooth extraction in creating tooth size discrepancies before
several investigators over the years. Bolton[5] was the first to treatment. They found that Boltons values were statistically
publish his analysis of mesiodistal tooth size dimensions and significant for the first premolar extraction and insignificant for
their effect on occlusion. He proposed that the overall ratio of others. They concluded that the removal of the first 4 premolars
the sum of mesiodistal width of the 12 mandibular teeth divided created the most severe tooth size discrepancies, whereas the
by the sum of the 12maxillary teeth was 91.3%, and the anterior extraction of all 4second premolars crated fewer discrepancies.
ratio for the 6 upper and lower anterior teeth was 77.2%. Bolton
arranged tables to predict the congruity between the maxillary Rudolph etal.[18] reported that variation in the labiolingual tooth
and mandibular arches, and concluded that it results in ideal thickness might produce inaccuracies in the Bolton analysis.
overbite, ideal overjet, and ideal posterior occlusion. He also They designed and tested a new formula that took into account
emphasized that the tooth ratios could without difficulty be a the labiolingual tooth thickness for predicting anterior tooth size
diagnostic aid that could aid orthodontists to gain an insight discrepancies. They found that patients with thin incisor at the
into the functional and esthetic outcome of a case without the occlusion contact(<2.75mm) had a stronger correlation with
use of diagnostic setup. intermaxillary ratio than patients with thick teeth(>2.75mm).
The higher correlation coefficient for the thin teeth indicates
Lundstrom[16] observed a large biological dispersion in the that size discrepancies in these cases by using this method
tooth size ratio, which was great enough to have an impact on are more sensitive. In case of thick incisors, the sensitivity of
the final teeth position, teeth alignment overbite, and overjet this method in predicting tooth size discrepancies decreases,
in a large number of patients. However, other investigators and a diagnostic setup may be indicated. Killiany[23] noted that
have speculated that incisor inclination,[17] interincisal angle, including the tooth thickness in the prediction model would
labiolingual tooth thickness[17,18] overbite, and overjet might improve the detection of intermaxillary tooth size discrepancy.
influence ideal tooth size relationship. Despite this, many However, the analysis is still not as accurate as using a
clinicians are still using Bolton analysis as their primary guide diagnostic setup.
for predicting tooth size discrepancies.
Nie and Lin[24] conducted a study among Chinese population
Lavelle [19] investigated tooth size ratio in different racial to compare intermaxillary tooth size discrepancies among
groups(Caucasoid, Mongoloid, and Negroid). Forty cases in different malocclusion groups for both sexes. They found
each group were investigated. He found that the overall and significant difference in tooth size ratios between the groups
anterior ratios were greater among Negroids than Caucasoids, in which ClassIII group had a higher mean value than ClassI
whereas the Mongoloids were intermediate. and ClassII(CLIII>CLI>CLII). However, sexual dimorphism
for these ratios did not exist in each group.
Crosby and Alexander[20] conducted a study on the occurrence
of tooth size discrepancies among patients with different Heusden etal.[25] carried out an experimental study on the effect
malocclusions(Classes I, II; division 1 and 2; and ClassII of tooth size discrepancies on occlusion. They observed that
surgical cases). They reported no difference in the incidence of severe tooth size discrepancies only slightly affect occlusion,
tooth size discrepancies in different malocclusion groups. They and the effect of generalized tooth size discrepancies appears
observed, however, that a large number of patients within each to be limited.
group had tooth size discrepancies greater than two standard
deviations of Boltons mean. Basaran etal.[26] performed tooth size measurements on
pretreatment models of patients with normal occlusion. The
Lew and Keng[21] carried out an odontometric measurement tooth size ratios and oneway analysis of variance test showed
of anterior teeth crowns size in a Chinese population sample no sexual dimorphism for these ratios in each of the five
with normal occlusion. They pointed out that tooth size ratio for groups, hence, the sexes were combined for each group. Then,
the 6 anterior teeth compared favorably with those originally these ratios were compared among different malocclusion
published by Bolton,[5] although the interincisal angle, overbite, groups. The results showed no significant difference between
and overjet were statistically different. subcategories of malocclusion, and hence these groups were
combined as ClassI, ClassII, and ClassIII. No significant
Hashim and Murshid[22] investigated the intermaxillary tooth difference was found for all the ratios between the groups.
size ratio in Saudi individuals aged 13 to 20years with different
type of malocclusions. They found no significant difference in Uysal etal.[27] aimed to identify the possible sex differences
the mean of tooth size ratio of overall and anterior ratios when in tooth size ratios between males and females to determine
compared with Boltons mean. Their study confirmed previous whether there is a difference in the incidence of tooth size
reports that different types of malocclusions do not affect the discrepancies for both the anterior and overall ratios when
Bolton ratio. comparing with Angle ClassI; ClassII, division 1; ClassII,

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Hashim, etal.: Bolton tooth ratio

division 2; and ClassIII malocclusion groups. Their result Sum of mesodistal tooth width of mandibular 36 to
revealed that significant sex difference was found only in the 46_Overalll ratio
overall ratio for normal occlusion individuals(P<0.001). All Sum of mesodistal tooth width of maxillary 16 to 26
malocclusion groups showed statistically significant higher
overall ratios than the normal occlusion group(P<0.001).
Sum of mesodistal tooth width of mandibular 33 to
There were no statistically significant differences among
or ratio
malocclusion groups. They recommended that further 100
Sum of mesodistal tooth width of maxillary 13 to 2
investigations are needed to explain the probable racial
differences and relationships between malocclusion and tooth
size measurements. Error of the Method
Ten orthodontic casts were selected randomly and measured
When searching the literature, no odontometric study was and remeasured with 1week interval by one of the
noted among Qatari population. Furthermore, no previous study coauthors(HA).
investigated the intermaxillary tooth size ratio(Bolton ratio)
among the Qatari population. Thus, the aims of the present Statistical Analysis
investigation were to establish the overall and anterior ratio Students ttest was used to assess the error of the method, and
among the Qatari population sample and to investigate whether to compare males and females, and to compare the result of
there was a significant difference between males and females, the present study and that of Boltons. The level of significance
as well as to compare it to the result obtained by Bolton. was P<0.05.


The present study consisted of 100 pretreatment When performing the ttest no statistical significant difference was
orthodontic casts of Qatari patients who sought orthodontic observed between the first and second measurements[Table1].
treatment(50males and 50females). The inclusion criteria Table2 presents the overall and anterior ratio of the present
were: study, i.e.,91.8(SD: 3.1) and 78.6(SD: 3.4), respectively. It
1. Qatari individuals. can be seen from Table3 that the mean anterior ratio for males
2. Age range from 15 to 20years. was 79.1(SD: 3.5) whereas for females was 78.1(SD: 3.3).
3. Class1, II, III molar and canine relationship.
Table4 shows that the overall ratio for males was 92.4(SD: 2.9)
4. Crowding, spacing(<3mm), and rotation of the teeth.
whereas for females was 91.2 with(SD: 3.2). The overall
5. No large interproximal restoration.
ratio and the anterior ratio were slightly greater in males than
6. No previous orthodontic treatment.
females[Table5]. No statistical significant differences were
7. All permanent teeth fully erupted in both jaws from the right
found in tooth size ratios between both the genders.
first molar to the left first molar.

The comparison of tooth size ratios between the present

Cast Measurement
study and Boltons result are presented in Table6. The results
The measurements were made directly on the unsoaped
reveal that the mean and standard deviation of the overall and
dental casts. One operator took all the measurements under
anterior ratio in the present study were slightly greater than
natural neon light. Electronic digital caliper was used in the
Boltons results. The statistical analysis exhibited no significant
measurements. The procedure for measuring the mesiodistal
difference in the overall ratio but showed statistical significant
tooth width was performed as described by Hunter and Priest.[28]
The caliper beaks were inserted from the buccal(labial) and difference in the anterior ratio.
held occlusally parallel to the long axis of the tooth. The beaks
were then closed until gentle contact with the contact points of DISCUSSION
the tooth was made.
Bolton stated that the mesiodistal tooth size of the maxillary
The measurements included the mesiodistal of 12maxillary and mandibular arches must relate to each other to obtain
and mandibular teeth from the right first permanent molar to an optimal occlusion at the completion of the orthodontic
left permanent first molar. The measurements were made as treatment. If a patient has significant toothsize discrepancy,
carefully as possible to avoid any damage on instrumental orthodontic alignment into optimal occlusion may not be
contact. possible.[5,18] Crosby and Alexander[20] reported that a large
percentage of orthodontic patients possess significant
To examine the tooth size relationship between the maxillary toothsize discrepancies. Therefore, orthodontists should be
and mandibular teeth, the Bolton formulae[5] were computed aware of these discrepancies before beginning an orthodontic
as follows: treatment.

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Table 1: Error of the method of the individual teeth in the upper and lower jaw
Upper jaw
Hc 16 15 14 13 12 11 21 22 23 24 25 26
Mean reading first week 9.7 6.577 6.786 7.64 6.847 8.491 8.453 6.853 7.638 6.752 6.488 9.666
Mean second week 9.75 6.574 6.886 7.667 6.811 8.611 8.6 6.875 7.648 6.715 6.502 9.796
P 0.816 0.982 0.682 0.908 0.863 0.647 0.580 0.891 0.969 0.868 0.941 0.584
Lower jaw
Mean reading first week 10.166 6.904 6.942 6.659 5.855 5.316 5.333 5.881 6.55 6.999 6.897 10.087
Mean reading second week 10.275 7.042 7.076 6.775 5.87 5.381 5.579 5.867 6.695 7.005 6.98 10.357
P 0.748 0.437 0.566 0.554 0.921 0.707 0.294 0.926 0.330 0.968 0.654 0.412
NS - Not significant

Table 2: Bolton overall ratio and anterior ratio for males and of relatively large teeth, modification of crown angulation or
females combined inclination, and extraction.[29]
Ratio type Mean SD Sample size
Overall ratio 91.8 3.1 100 Bolton[17] and Tuverson[30] indicated that overbite, overjet, and
Anterior ratio 78.6 3.4 100 interincisal angle might influence ideal toothsize relationships.
SD - Standard deviation However, no definite conclusions have been drawn regarding
the effect that overbite, overjet, and interincisal angle have on
Table 3: Bolton anterior ratio for males and females of the the accuracy of toothsize analysis. In the present study, the
present study intericisal angle was not included in the measurements.
Gender Mean SD Sample size
Males 79.1 3.5 50 When reviewing the literature, it was observed that most of the
Females 78.1 3.3 50 studies regarding toothsize ratio were conducted on a sample
SD - Standard deviation
of both treated and untreated cases[5,31,32] or on groups of
orthodontic patients with malocclusion.[20] However, the present
Table 4: Bolton overall ratio for males and females of the study data were collected from a sample of untreated individuals
present study
who presented with different malocclusions. The results
Gender Mean SD Sample size
show that the mean of the overall ratio was not statistically
Males 92.4 2.9 50
significant from Boltons[5] results whereas the anterior ratio
Females 91.2 3.2 50
showed statistical significant difference. This difference could
SD - Standard deviation
be attributed to the presence of several patients presented with
ClassIII malocclusion. As mentioned earlier in the study of Nie
Table 5: Comparison of overall and anterior ratio means values
and Lin[24] who found a significant difference in toothsize ratios
of the present study between males and females
between the groups in which Class111 group had a higher
Ratio type Gender N Mean SD P P
mean value than ClassI and ClassII. The same finding was
Overall ratio Males 50 92.4 2.9 0.0.1122 NS
reported by Othman and Harradine.[34]
Females 50 91.2 3.2
Anterior ratio Males 50 79.1 3.5 0.1122 NS
Females 50 78.1 3.3 However, Basaran[26] observed no significant difference for
NS - Not signifi cant; SD - Standard deviation
both ratios between the groups of malocclusion, which is in
disagreement with the results of Othman and Harradine[34]
Table 6: Comparison between the present study result and
and Nie and lin. [24] Crosby and Alexander supported the
Boltons means values same finding.[20] They conducted a study in orthodontically
N Mean SD P P treated patients with varying malocclusions(ClassI, ClassII,
Overall ratio Division 1, ClassII Division 2, and ClassII surgery) and
Present study 100 91.8 3.1 0.305 NS concluded that no significant differences in the incidence of
Bolton study 55 91.3 1.91 toothsize discrepancies among the malocclusion groups.
Anterior ratio Comparison between the present and abovementioned studies
Present study 100 78.6 3.4 0.007 S is not relevant because the sample of the present study was
Bolton study 55 77.2 1.65 not classified into different malocclusion classes.
NS - Not signifi cant; S - Signifi cant; SD - Standard deviation
However, the results of the present investigation were in
The treatment alternatives for toothsize discrepancies include agreement with the results reported by Nie and Lin[24] in a
restoration of relatively small teeth, interproximal stripping Chinese population where no significant difference in toothsize

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Hashim, etal.: Bolton tooth ratio

ratios was observed between the combined groups of Conflict of Interest

malocclusion and normal occlusion. Hashim and Murshid noted There is no conflict of interest.
the same result.[22] They investigated toothsize discrepancies
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