Investigating the Relationships Among Age, Occlusal Traits, and Malocclusion Severity in Preschool Children. A Cross-sectional Study

Investigating the Relationships Among Age, Occlusal Traits, and Malocclusion Severity in Preschool Children. 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A Cross-sectional Study Elona Kongo, Busra Emir, Ilda Gribizi, Beatrice Manes Gravina This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7261330/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : The aim of this cross-sectional epidemiological study was to explore the associations of age and occlusal factors with the severity of malocclusion among preschool children attending public kindergarten in Tirana, the capital city of Albania. Methods: Clinical data regarding malocclusion traits were collected from October 2023-May 2024 by examining 3- to 6-year-old children who were frequenting 18 randomly selected public kindergartens in Tirana, Albania. A child presenting one of the following altered occlusal traits was recorded as having malocclusion: class II or III canine relationship, distal step (Ds), increased overjet (OVJ), deep overbite (OVB) >50% or anterior open bite (AOB), cross bite (CB) either anterior (ACB) or posterior (PCB). The relationships between categorical variables were evaluated with the continuity correction test, Fisher’s exact test for 2 × 2 tables and the Pearson chi-square test for r × c tables. Binary logistic regression analysis and multivariable logistic regression analysis were used to determine the risk factors affecting a child’s malocclusion severity. Results: A total of 719 children aged 3–6 years (362 females and 357 males) with a mean age of 4.03 years who met the inclusion criteria were included in the study. There were no differences in terms of age or sex. The OVJ frequency and incidence of deep OVB>50% were 15.4%, and deep OVB was more common in the 4-year-old group. The incidence of AOB was 2.6%, which was greater among 5-year-old children. The multivariate regression analysis revealed that children in the 4-year-old group had a 1.62-fold greater risk of developing severe malocclusion (OR (95% CI):1.62 (1.05–2.50); p =0.030). Those with increased OVJ had a 15.15-fold greater risk of developing more severe malocclusion (OR (95% CI):15.15 (5.87–39.09) p <0.001). Conclusions: The results of this study demonstrate that an age of 4 years, increased OVJ, a class III canine relationship and primary second molars in Ds are factors associated with the severity of malocclusion among preschool children. Dentistry malocclusion occlusal traits preschool children Background Early childhood is a particularly important stage, as it affects normal growth and development. During this stage, genetic or even environmental factors can affect growth and development, causing malocclusion [1]. Considering that oral health might be affected by malocclusion [2], oral health management, which aims to establish healthy dentition and alleviate or avoid malocclusion from the eruption of the first primary tooth to the accomplishment of young permanent dentition, is highly important in the pediatric population [3]. Hence, early detection of malocclusion traits and associated risk factors is crucial for restoring normal occlusal development and overall oral health [4,5]. Indeed, it has been suggested that the removal of risk factors impacts the prevalence and severity of existing malocclusion [6]. A prospective cohort study conducted among 3-year-old German children concluded that nonnutritive sucking habits were risk factors for the development of malocclusion [7]. Moreover, a recent study revealed that thumb/digit sucking habits contribute to masticatory difficulties [8]. Therefore, the management of oral functionality, which consists of the correction of poor oral habits, is among the objectives of early orthodontic treatment [9]. Certain features of primary dentition can contribute to malocclusion in permanent dentition. According to Ngan, among such conditions are early loss of primary teeth, mesioclusion or distoclusion, cross bite (CB), anterior open bite (AOB) and deep bite [10]. Additionally, class II occlusal characteristics,such as a Ds class II primary canine relationship and increased OVJ already present in the primary dentition during the transition to mixed dentition, are maintained or worsen [11]. A recent longitudinal study that monitored 5-year-old children revealed that the probability of presenting malocclusion in mixed dentition increases if CB and increased OVJ are present in the primary dentition stage [12]. Current evidence confirms that during the transition from temporary dentition to permanent dentition, various changes related to growth or environmental factors may occur [13, 14]. Therefore, continuous monitoring is recommended [6]. In addition to dental health, psychosocial well-being and social well-being are disadvantages of malocclusion [9]. It is believed that maintaining good oral health throughout childhood not only provides a solid foundation for good oral function in adulthood but also has beneficial effects on the quality of life of families [15]. A cross-sectional epidemiologic study revealed that AOB was associated with a negative impact on quality of life among preschool children and their families [16]. Moreover, Sakaryalireported that only severe malocclusion had a statistically significant effect on children, but both simple and severe malocclusion had significantly negative effects on parents [17]. Data regarding the prevalence and features of malocclusion among Albanian preschool children are limited. Thus, the aim of this study was to explore the associations of age and occlusal traits with the severity of malocclusion among preschool children attending public kindergartens in Tirana, the capital city of Albania. Materials and methods This descriptive cross-sectional epidemiological study was conducted from October 2023May 2024. After permission was obtained from the local authorities, 18 kindergartens were randomly selected. Prior to the examinations, written informed consent was obtained from the parents as well. In addition to permission to visit the children, parents were also given a short questionnaire as described in a previous study [18].The children included in the study fulfilled the following criteria: 1) Albanian ethnicity; 2) 3–6 years old; 3) no oral syndromes/clefts; 4) no history of orthodontic treatment; and 5) present at the day of examination, with parental consent. The exclusion criteria were as follows: 1) refusal from parents and 2) non collaborative children. The clinical data were collected from 2 orthodontic specialists, E.K. and I.G. (each with more than 10 years of clinical experience in orthodontics), on a specific form created for the present study. The number of necessary participants was 386 according to the formula n = z2 p(1-p)/e2;however, to assure the most similar participants for each age group, the final sample included 719 children. Intraexaminer and interexaminer reliability was assessed using Cohen’s kappa coefficient via duplicate examinations of 30 children. The intraexaminer reliability yielded a kappa value of 0.82, indicating substantial agreement, while the interexaminer reliability resulted in a kappa of 0.74, reflecting moderate to substantial agreement. The dental examination was carried out in every kindergarten room under natural daylight with respect to infection control by using disposable examination gloves and sterile mouth mirrors and explorers. Occlusion was assessed while each child was biting on his or her posterior teeth with the jaws in a centric relationship (maximal intercuspation). Malocclusion was recorded via a protocol proposed in previous similar studies [1, 14]. The following occlusal traits were recorded: Primary molar relationship: Flush terminal plane (Ftp): The distal surfaces of the maxillary and mandibular primary second molars were in the same vertical plane. Distal step (Ds): The distal surface of the mandibular primary second molar was distal to that of the maxillary primary second molar. Mesial step (Ms): The distal surface of the mandibular primary second molar was mesial to that of the maxillary primary second molar. Primary canine relationship: Class I: The cusp tip of the maxillary primary canine tooth was on the same vertical plane as the distal surface of the mandibular primary canine. Class II: The cusp tip of the maxillary primary canine tooth was mesial to the distal surface of the mandibular primary canine. Class III: The cusp tip of the maxillary primary canine tooth was distal to the distal surface of the mandibular primary canine. - Overjet (OVJ), expressed in mm, was measured from the midpoint of the labial surface of the most anterior lower central incisor to the midpoint of the labial surface of the most anterior upper central incisor. It was categorized as normal (0–3 mm) or increased (≥4 mm). - Overbite (OVB), expressed in mm, was measured as the vertical distance between the incisal edges of the upper and lower central incisors. It was categorized as follows: normal (0–50%), deep overbite (> 50%), or open bite. - Anterior crossbite (ACB) was recorded as present when one or more of the maxillary incisors/canines occluded lingually relative to the mandibular incisors/canines. -Posterior crossbite (PCB) was recorded as present when one or more of the maxillary molars occluded lingually to the mandibular molars. -Scissor bite was recorded when maxillary molars occluded the buccal surfaces of the corresponding mandibular molars and/or mandibular molars occluded the lingual surfaces of the corresponding maxillary molars. A child presenting one of more of the following altered occlusal traits was recorded as having malocclusion: class II or III canine relationship; Ds; increased OVJ; deep OVB>50%; or AOB, CB, ACB or PCB. Furthermore, children with malocclusion were analyzed according to the number of altered occlusal traits from 1-4. Statistical analysis The data were evaluated via the statistical package program IBM SPSS Statistics 25.0 (IBM Corp., Armonk, New York, USA). Categorical variables are presented as frequencies and percentages. The relationships between categorical variables were evaluated with the continuity correction test, Fisher’s exact test for 2 × 2 tables and the Pearson chi-square test for r × c tables. Binary logistic regression analysis and multivariable logistic regression analysis were used to determine the risk factors affecting a child’s malocclusion severity. As a result of the logistic regression analysis of risk factors, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated according to the reference category for each variable. A value of p <0.05 was considered statistically significant. Regarding the assumptions of logistic regression, we verified key model assumptions prior to analysis. Multicollinearity was assessed using variance inflation factors (VIF), with all covariates showing acceptable values (VIF < 2.5). The linearity of continuous covariates with the logit of the outcome was evaluated using the Box-Tidwell test, and no violations were detected. Furthermore, model fit was assessed using the Hosmer-Lemeshow goodness-of-fit test, which indicated adequate calibration (p > 0.05). Results A total of 719 children aged 3–6 years (362 females and 357 males), with a mean age of 4.03 years, who met the inclusion criteria were included in the study. There were no differences in terms of age or sex distribution (Table 1 ). The prevalence of children without malocclusion was 43.7% (174 females and 140 males). More than half of the children with malocclusion had one type of malocclusion (116 females and 126 males). Only 8 children had 4 types of malocclusions. There were significant differences in terms of malocclusion severity and sex ( p = 0.034). Table 1 Statistical comparisons according to age, sex and malocclusion type. Sex Female ( n = 362) Male ( n = 357) P value Age (years) n (%) n (%) 3 99 (27.3) 108 (30.3) 0.639 X ² 4 138 (38.1) 135 (37.8) 5 125 (34.5) 114 (31.9) Malocclusion No malocclusion 174 (48.1) 140 (39.2) 0.034 X ² 1 type 116 (32.0) 126 (35.3) 2 types 59 (16.3) 63 (17.6) 3 types 11 (3.0) 20 (5.6) 4 types 2 (0.6) 8 (2.2) X ² Pearson chi-square test, A comparison of occlusal traits according to age group is shown in Table 2 . Molar relationship Ftp and Ms were more common in the 4-year-old group, with a minimal difference between sexes, but compared with the other age groups, the difference was significant ( p = 0.020). The 3- and 4-year-old groups had similar frequencies of Ds, but the difference was not statistically significant ( p = 0.576). Canine relationship Compared with the other classes, class I malocclusion was more prevalent in boys (43/68 = 63.23%) than in girls in the 4-year-old group (p = 0.013) (Table 2 ).The similar frequency between sexes (24) in the 5-year-old group was the highest for the class II canine relationship. A significant difference in the canine relationship was not observed between the groups. The frequency of increased OVJ > 4 mm and OVB > 50% was 15.4%, and OVJ > 4 mm was more common in the 4-year-old group. There were no significant differences among the three groups in OVJ ( p = 0.733) or OVB ( p = 0.4497). The prevalence of AOB was 2.6%, which was greater among 5-year-old children. The prevalence of unilateral CB was 3%, which was similar among 3- and 5-year-old children. The bilateral CB prevalence was 1.2%, with a similar frequency in both sexes in 3-year-old children, whereas there were no male children with bilateral CB in the 2 other age groups. ACB was observed in 3.3% of the whole sample and was slightly more common among 5-year-old children. There were no significant differences in CB among the unilateral, bilateral ( p = 0.960) and anterior ( p = 0.168) groups. In terms of malocclusion severity, which was measured by how many types of altered occlusal parameters were observed in a child, our results indicate that there were more children with one type of malocclusion among the 4-year-old children (13.9%) than among the 5-year-old (10.8%) and 3-year-old (8.9%) children. Table 2 Statistical comparisons by age group 3 Years 4 Years 5 Years Variable Characteristic Female n ( % ) Male n ( % ) P value Female n ( % ) Male n ( % ) P value Female n ( % ) Male n ( % ) P value P value (For age group comparisons) Molar relationship Flush No Yes 29 (29.3) 70 (70.7) 34 (31.5) 74 (68.5) 0.732 X ² 51 (37.0) 87 (63.0) 46 (34.1) 89 (65.9) 0.619 X ² 55 (44.0) 70 (56.0) 48 (42.1) 66 (57.9) 0.768 X ² 0.020 X ²+ Mesial step No Yes 78 (78.8) 21 (21.2) 86 (79.6) 22 (20.4) 3.94 X ²C 97 (70.3) 41 (29.7) 101 (74.8) 34 (25.2) 0.402 X ² 84 (67.2) 41 (32.8) 80 (70.2) 34 (29.8) 0.621 X ² 0.040 X ²+ Distal step No Yes 92 (92.9) 7 (7.1) 96 (88.9) 12 (11.1) 0.444 X ²C 131 (94.9) 7 (5.1) 123 (91.1) 12 (8.9) 0.242 X ²F 114 (91.2) 11 (8.8) 103 (90.4) 11 (9.6) 0.998 X ²C 0.576 X ² Asymmetric No Yes 98 (99.0) 1 (1.0) 108 (100.0) 0 (0.0) 0.478 X ²F 135 (97.8) 3 (2.2) 135 (100.0) 0 (0.0) 0.247 X ²C 122 (97.6) 3 (2.4) 111 (97.4) 3 (2.6) 1.000 X ²F 0.165 X ² Canine relationship Class I No Yes 21 (21.2) 78 (78.8) 30 (27.8) 78 (72.2) 0.273 X ² 25 (18.1) 113 (81.9) 43 (31.9) 92 (68.1) 0.013 X ²C 30 (24.0) 95 (76.0) 31 (27.2) 83 (72.8) 0.572 X ² 0.975 X ² Class II No Yes 80 (80.8) 19 (19.2) 85 (78.7) 23 (21.3) 0.707 X ² 119 (86.2) 19 (13.8) 102 (75.6) 33 (24.4) 0.036 X ²C 101 (80.8) 24 (19.2) 90 (78.9) 24 (21.1) 0.721 X ² 0.932 X ² Class III No Yes 97 (98.0) 2 (2.0) 101 (93.5) 7 (6.5) 0.218 X ²C 135 (97.8) 3 (2.2) 126 (93.3) 9 (6.7) 0.082 X ²F 120 (96.0) 5 (4.0) 107 (93.9) 7 (6.1) 0.645 X ²C 0.927 X ² Asymmetric No Yes 99 (100.0) 0 (0.0) 108 (100.0) 0 (0.0) - 135 (97.8) 3 (2.2) 134 (99.3) 1 (0.7) 0.622 X ²F 124 (99.2) 1 (0.8) 114 (100.0) 0 (0.0) 3.94 X ²F 0.143 X ² Overjet Normal (0–3 mm) No Yes 18 (18.2) 81 (81.8) 21 (19.4) 87 (80.6) 0.816 X ² 16 (11.6) 122 (88.4) 26 (19.3) 109 (80.7) 0.112 X ²C 20 (16.0) 105 (84.0) 23 (20.2) 91 (79.8) 0.502 X ²C 0.570 X ² Increased (≥ 4 mm) No Yes 83 (83.8) 16 (16.2) 89 (82.4) 19 (17.6) 0.784 X ² 123 (89.1) 15 (10.9) 111 (82.2) 24 (17.8) 0.145 X ²C 107 (85.6) 18 (14.4) 95 (83.3) 19 (16.7) 0.760 X ²C 0.733 X ² Overbite Normal (0–50%) 86 (86.9) 88 (81.5) 0.485 X ² 112 (81.2) 107 (79.3) 0.793 X ² 104 (83.2) 92 (80.7) 0.725 X ² 0.497 X ² Deep overbite (> 50%) 10 (10.0) 17 (15.7) 23 (16.7) 26 (19.3) 18 (14.4) 17 (14.9) AOB 3 (3.0) 3 (2.8) 3 (2.2) 2 (1.5) 3 (2.4) 5 (4.4) Crossbite No CB Unilateral PCB Bilateral CB 95 (96.0) 3 (3.0) 1 (1.0) 103 (95.4) 4 (3.7) 1 (0.9) 3.94 X ² 130 (94.2) 5 (3.6) 3 (2.2) 132 (97.8) 3 (2.2) 0 (0.0) 0.235 X ² 116 (92.8) 5 (4.0) 4 (3.2) 112 (98.2) 2 (1.8) 0 (0.0) 0.090 X ² 0.960 X ² ACB No Yes 97 (98.0) 2 (2.0) 107 (99.1) 1 (0.9) 0.939 X ²C 133 (96.4) 5 (3.6) 130 (96.3) 5 (3.7) 1.000 X ²F 120 (96.0) 5 (4.0) 108 (94.7) 6 (5.3) 0.761 X ²F 0.168 X ² Brodie No Yes 99 (100.0) 0 (0.0) 107 (99.1) 1 (0.9) 1.000 X ²F 138 (100.0) 0 (0.0) 134 (99.3) 1 (0.7) 0.495 X ²F 125 (100.0) 0 (0.0) 114 (100.0) 0 (0.0) - 0.745 X ² Malocclusion No malocclusion 1 type 2 types 3 types 4 types 48 (48.5) 34 (34.3) 13 (13.1) 2 (2.0) 2 (2.0) 49 (45.4) 30 (27.8) 21 (19.4) 6 (5.6) 2 (1.9) 0.440 X ² 57 (41.3) 53 (38.4) 27 (19.6) 1 (0.7) 0 (0.0) 52 (38.5) 47 (34.8) 27 (20.0) 6 (4.4) 3 (2.2) 0.129 X ² 69 (55.2) a 29 (23.2) a 19 (15.2) a 8 (6.4) a 0 (0.0) a 39 (34.2) b 49 (43.0) b 15 (13.2) a 8 (7.0) a 3 (2.6) a 3.94 X ² 0.206 X ² X ² Pearson chi-square test, X ²C continuity correction test, X ²F Fisher’s exact test. The flush distribution of the + 3- to 5-year-old age groups was statistically significant. Additionally, the mesial distribution of the 3-5-year-old age groups was statistically significant. Superscript a and b indicate a statistically significant difference. Table 3 Factors affecting a child’s risk of severe malocclusion according to binary logistic regression Univariate Multivariate Variable OR (95% CI) P value OR (95% CI) P value Age (years) < 0.001 0.046 3 Reference Reference 4 1.50 (1.18–1.92) < 0.001 1.62 (1.05–2.50) 0.030 5 1.21 (0.94–1.56) 0.137 1.05 (0.66–1.67) 0.821 Sex Female Reference Male 1.55 (1.25–1.92) < 0.001 - - Left molar < 0.001 < 0.001 Flush Reference Reference Mesial 0.93 (0.70–1.23) 0.614 0.97 (0.65–1.44) 0.872 Distal 14.00 (5.08–38.61) < 0.001 8.15 (2.70–24.60) < 0.001 Right molar < 0.001 Flush Reference Mesial 0.92 (0.70–1.22) 0.924 - - Distal 14.25 (5.17–39.27) < 0.001 - - Asymmetrical No Reference Yes 1.00 (0.29–3.45) 1.000 - - Flush No Reference Yes 1.22 (1.02–1.47) 0.032 - - Mesial No Reference Yes 0.93 (0.70–1.23) 0.614 - - Distal No Reference Yes 14.00 (5.08–38.61) < 0.001 - - Left canine < 0.001 < 0.001 1 Reference Reference 2 27.60 (11.31–67.36) < 0.001 12.04 (4.67–31.02) < 0.001 3 15.50 (3.71–64.76) < 0.001 5.22 (1.13–24.07) < 0.001 Right canine < 0.001 1 Reference 2 23.33 (10.31–52.83) < 0.001 - - 3 15.50 (3.71–64.76) < 0.001 - - Canine asymmetric No Reference Yes 0.67 (0.11–3.99) 0.657 - - Canine relationship 1 No Reference Yes 0.77 (0.65–0.91) 0.002 0.46 (0.32–0.66) < 0.001 Canine relationship 2 No Reference Yes 34.50 (12.77–93.23) < 0.001 - - Canine relationship 3 No Reference Yes 15.50 (3.71–64.76) < 0.001 - - OVJ normal (0–3 mm) No Reference Yes 0.93 (0.79–1.09) 0.346 - - OVJ increased (≥ 4 mm) No Reference Yes 21.20 (8.65–51.98) < 0.001 15.15 (5.87–39.09) < 0.001 ACB No Reference Yes 3.00 (1.19–7.56) 0.020 - - PCB 0.036 0.096 No CB Reference Reference Uni 2.67 (1.04–6.81) 0.040 2.25 (0.77–6.55) 0.137 Bi 3.50 (0.73–16.85) 0.118 3.94 (0.73–21.13) 0.110 OR odds ratio, CI confidence interval Table 3 presents the binary logistic regression results. According to the univariate model results, independent variables were first considered separately. When the 3-year-old age group was used as a reference, the risk of severe malocclusion was 1.5 times greater than when the 4-year-old group was used as a reference (p < 0.001). Males had a 1.55-fold greater risk than did females (p < 0.001). The Ds and canine class III relationships were associated with 14-fold (p < 0.001) and 15.5-fold greater risks, respectively (p < 0.001). Increased OVJ was associated with 21.2 times greater than no increased OVJ (p < 0.001). Children with ACB were at 3 times greater risk of severe malocclusion than those without ACB (p = 0.020). Those with unilateral PCB were 2.67 times more prone to severe malocclusion than those without (p = 0.04). Multivariable logistic regression analysis including variables found to be significant on univariate logistic regression analysis was then performed, and a single model was created. Children in the 4-year-old group had a 1.62-fold greater risk of developing severe malocclusion than those in the 3-year-old group (OR (95% CI):1.62 (1.05–2.50); p = 0.030). Those with increased OVJ had a 15.15-fold greater risk of developing more severe malocclusion (OR (95% CI):15.15 (5.87–39.09) p < 0.001). Discussion The objective of this study was to explore the associations of age and occlusal traits with the severity of malocclusion among preschool children. In general, the results show that malocclusion is widespread and that severity is affected by age and occlusal traits. The current literature demonstrates a strong consensus on the high prevalence of malocclusion in preschool children [1, 4, 14, 19]. In addition to the agreement regarding prevalence, our study results are consistent with those of previous studies in terms of the most common type of malocclusion [1, 14, 20, 21]. In this study, the most frequent malocclusion types were increased OVJ and deep OVB, both with similar prevalence rates (15.4%). The prevalence observed among Saudi Arabian children was greater for both OVJ and OVB [14]. According to the authors, the disparity observed with data from the same population was attributed to differences in lifestyle, diet and maladaptive oral behaviors. The multivariate regression analysis revealed that children with increased OVJ had a 15.15-fold greater risk of developing more severe malocclusion (OR (95% CI):15.15 (5.87–39.09) p 4mm was used to identify increased OVJ, indicating a greater risk for dental trauma, especially if the increased OVJ is combined with incomplete lip closure [21]. Increased OVJ is the consequence of oral habits and is considered a risk factor for moderate and severe malocclusion [5,22]. Compared with other habits, thumb/digit sucking not only has an effect on malocclusion prevalence [7] but also significantly greater increases the prevalence of increased OVJ compared with a pacifier habit [23]. Moreover, a recent cross-sectional study among Brazilian preschoolers concluded that children who were never breastfed and used a pacifier had a higher prevalence of malocclusion [19]. According to Feldens et al. bottle feeding is a risk factor for the discontinuation of breastfeeding and is also associated with pacifier use [24]. However, regardless of the particular type, oral habits can contribute to malocclusion and disrupt proper dental and jaw development [25, 26]. If a habit continues after the age of 4 years, there will be detrimental effects on occlusion at the age of 5 years [23]. Research has revealed a correlation between age and the features of malocclusion within this age group. Findings suggest that the prevalence of malocclusion tends to decrease during growth [6, 13, 20, 27]. Indeed, the decrease in oral habits with increasing age suggests that functional improvement can lead to improvements in malocclusion [5, 24]. The regression analysis performed in this study revealed that children in the 4-year-old group had a 1.62-fold greater risk of developing severe malocclusion than those in the 3-year-old group (OR (95% CI):1.62 (1.05–2.50); p = 0.030). Thus, the increased risk of developing severe malocclusion in younger children noted in this study seems to be related to the reduced tendency to practice oral habits observed in older children [3, 6]. Another distinct feature of malocclusion observed during the primary dentition stage is that certain types may resolve spontaneously [8, 13]. Knowledge of those malocclusion types that may exhibit spontaneous correction, such as CB, is important when planning early orthodontic treatment [28]. Of particular interest are the results of a French study involving 422 three-year-old children, which found PCB in 20% of the participants. The authors concluded that preterm birth and non-nutritive sucking habits are significant risk factors for the early development of PCB [29]. Moreover, if left untreated, CB may lead to the development of more severe malocclusion [28, 30]. Nevertheless, recent findings suggest that CB treatment should not be started before the eruption of the first permanent molar [28], perhaps except in exceptional cases with very asymmetrical facial growth [10]. In terms of the prevalence of CB, either ACB (3.3%) or PCB (3.05%), our results align with those of similar previous research [4, 27]. Although the prevalence is low, univariate model results indicate that children with ACB have a three-time greater risk of severe malocclusion than those without ACB (p = 0.020). Similarly, children with unilateral PCB are at 2.67-times greater risk than those without PCB (p = 0.040). These findings are consistent with the conclusions of a recent study, which suggested that children may develop PCB during the mixed dentition phase, even when a normal transverse relationship is observed in the deciduous dentition [11]. The most prevalent primary molar relationship in this study was Ftp, which was observed in 63.4% of the included children. This result aligns with those of a previous study among Turkish children [4] but contradicts a prevalence reported among Saudi Arabian children [14]. We also found that the tendency for Ms increased with increasing age, which is also supported by previous studies [30, 31]. According to Barros [32], Ms was the most frequent terminal relationship of the primary second molars in mixed dentition, which produced an early and stable class I relationship for the permanent first molars. Moreover, considering that Bishara [33] suggested that slightly more than half of Ftp cases will progress to a normal class I molar relationship, it seems plausible to conclude that there is a slight increase in the likelihood of class I malocclusion. However, for an individual to be considered to have normal occlusion Ftp is not sufficient; other dental and skeletal parameters must also be considered [23]. In addition to the class I canine relationship, minimal OVJ and OVB may contribute to the proper transition to permanent dentition [34]. Studies have shown that certain features of primary dentition can serve as early indicators for the development of malocclusion in permanent dentition. For example, Bacetti [11] reported that the presence of a Ds molar relationship and increased OVJ in primary dentition are associated with the development of a class II molar relationship in permanent dentition. Similarly, Kirzioglu [30] et al. reported that a class III canine relationship in the primary dentition can be a predictive factor for future malocclusion. In this study, children presenting with a class II or III canine relationship, along with Ds, increased OVJ, and increased OVB, were classified as having malocclusion. The results revealed that the presence of a distal step molar relationship and a class III canine relationship were associated with a 14-fold (p < 0.001) and 15.5-fold (p < 0.001) increased risk of developing malocclusion, respectively. These findings not only confirm the strong association between these altered occlusal traits and malocclusion but also reflect the severity of the condition when such features are present. A comparison with a previous study [35] involving the same population of Albanian preschool children revealed discrepancies in the prevalence of certain malocclusion traits. Notably, a previous study revealed a greater prevalence of class III primary canine relationships (10.7% vs. 5.4%) and ACB (10.2% vs. 3.3%). These differences may be attributed to several factors, including variations in the protocols used to assess malocclusion, the larger sample size in the current study, and changes in the recruitment area. While the earlier study focused on children from the northern region of the country, the present study included participants from the capital. It is plausible that differences in socioeconomic conditions between regions may have contributed to the variation in malocclusion prevalence, as suggested by Gomes et al . [26]. This study has several limitations that should be acknowledged. First, the cross-sectional design limits causal inferences; observed associations do not imply cause-effect relationships. Therefore, while we report odds ratios as measures of association, these should not be interpreted as indicators of causality. This limitation is inherent to the study design and should be considered when interpreting the findings. Longitudinal research would be necessary to confirm causal pathways. A second limitation of this study is the unequal distribution of children across age groups, which was partly due to the limited number of fully completed parental questionnaires. Consequently, the study did not evaluate socioeconomic status or non-nutritive sucking habits, both of which are known to affect occlusal development. In addition, the exclusion of children attending private kindergartens may have introduced a degree of selection bias. Furthermore, children attending private kindergartens were not included, which may have introduced a degree of selection bias. Despite these limitations, the study benefits from a robust sample size and offers valuable insights into the prevalence of malocclusion and associated variables in the primary dentition of Albanian children. Given the historical lack of preventive and interceptive strategies targeting malocclusions in this age group, the findings of this research are expected to be valuable to public health authorities. Nonetheless, further research is warranted to address the current study's limitations and to confirm its findings. Future studies should aim to assess the role of oral habits and include representative samples from all regions of Albania to provide a more comprehensive understanding of malocclusion patterns at the national level. Conclusion In conclusion, the results of this study demonstrate that an age of 4 years, an increased OVJ, a class III canine relationship and primary second molars in Ds are factors associated with the severity of malocclusion among preschool children. Declarations Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of Albanian University (protocol code: 434;date of approval: 24/05/2023). Written informed consent was obtained from the parents. Consent for publication: Not applicable Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no competing interests. Funding This research was funded by Albanian University. Author contributions: Conception of the study, E.K., I.G. and B.G.; collection of clinical data,E.K. and I.G.; data analysis and interpretation, B.E. and B.G.; writing—original draft preparation, E.K.,I.G. and B.E. All the authors have read and approved the final manuscript. Acknowledgments The authors thank Mrs. Enkeleda Isaku, Head of theGeneral Directorate of Nurseries and Kindergartens, Tirana, Albania, and Dr. Aurela Fshati. Conflicts of interest The author(s) declare(s) no conflicts of interest. References Otsugu M, Sasaki Y, Mikasa Y, Kadono M, Sasaki H, Kato T, Nakano K. Incompetent lip seal and nail biting as risk factors for malocclusion in Japanese preschool children aged 3–6 years. BMC pediatrics. 2023; 26; 23:532. World Dental Federation. From Strictly Aesthetics to an Integral Part of Oral Health: A Brief History of Orthodontics through the Ages. Available online: https://www.fdiworlddental.org/strictly-aesthetics-integral-part-oral-health-brief-history-orthodonticsthrough-ages Moraes RB, Knorst JK, Pfeifer AB, Vargas‐Ferreira F, Ardenghi TM. Pathways to anterior open bite after changing of pacifier sucking habit in preschool children: A cohort study. International Journal of Paediatric Dentistry 2021; 31:278-84. Aktaş N, Palaz ZH, Akal N. The Evaluation of Occlusion Characteristic and Deleterious Oral Habits in 3-to 5-year-old Children. ADO KlinikBilimlerDergisi 2024; 13:303-11. Kongo E, Gaçe E, Gravina BM, Gribizi I, Gravina GM. A gender-based comparative study of the risk of malocclusion and occlusal traits among preschool-age children. Ann Stomatol. 2025 Apr 30; 5(1). Grippaudo MM, Quinzi V, Manai A, Paolantonio EG, Valente F, La Torre G, Marzo G. Orthodontic treatment need and timing: Assessment of evolutive malocclusion conditions and associated risk factors. Eur J Paediatr Dent 2020; 3:203-208. Wagner Y, Heinrich-Weltzien R. Occlusal characteristics in 3-year-old children–results of a birth cohort study. BMC Oral Health 2015; 15:1-6. Au Yeung KS, Shan Z, Sum FH, Wong KW, Lee HM, Yang Y. Association between occlusal features and masticatory function in Hong Kong preschool children: a survey with one-year longitudinal follow-up. BMC Oral Health. 2024; 5:24:187. Zhou C, Duan P, He H, Song J, Hu M, Liu Y, Liu Y, Guo J, Jin F, Cao Y, Jiang L. Expert consensus on pediatric orthodontic therapies of malocclusions in children. International Journal of Oral Science 2024;16; 1:32. Ngan P, Fields H. Orthodontic diagnosis and treatment planning in the primary dentition. ASDC Journal of Dentistry for Children 1995: 1:62:25 . Baccetti T, Franchi L, McNamara Jr JA, Tollaro I. Early dentofacial features of Class II malocclusion: a longitudinal study from the deciduous through the mixed dentition. American Journal of Orthodontics and Dentofacial Orthopedics 1997; 111:502-9 Dos Santos PR, Ambrosano GB, Ambrosano GB, de Castro Meneghim M, Vedovello SA. A longitudinal study of the probability of developing malocclusion in children using a Bayesian analysis. American Journal of Orthodontics and Dentofacial Orthopedics 2024; 25. Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in children at 3 and 7 years of age: a longitudinal study. The European Journal of Orthodontics 2013; 35:131-7. Abdellatif HM, Sawan N, Alabdulmohsen AM, AlKheraif G, AlKhonin H, Ali A, Elkateb MA. Prevalence and risk indicators of primary dentition malocclusion in Riyadh-Saudi Arabia using a new case definition: A cross-sectional study. The Saudi Dental Journal 2024; 36:60-5. Ravaghi, V., Holmes, R., Steele, J. et al. The impact of oral conditions on children in England, Wales and Northern Ireland 2013. Br Dent J 2016:173–178. Ramos-Jorge J, Motta T, Marques LS, Paiva SM, Ramos-Jorge ML. Association between anterior open bite and impact on quality of life of preschool children. Braz Oral Res 2015; 29:46. Sakaryali D, Bani ME, Cinar C, Alacam AL. Evaluation of the impact of early childhood caries, traumatic dental injury, and malocclusion on oral health–Related quality of life for Turkish preschool children and families. Nigerian journal of clinical practice 2019; 22:817-23. Kongo, E., Gaҫe, E., Gravina, G.M. et al. Cross-bite and oral habits among Albanian autistic children according to the stages of occlusal development. Sci Rep 2024b; 24:70004-6 Pegoraro ND, Santos CM, Colvara BC, Rech RS, Faustino-Silva DD, Hugo FN, Hilgert JB. Prevalence of malocclusion in early childhood and its associated factors in a primary care service in Brazil. InCoDAS 2021 Nov 22 (Vol. 34, p. e20210007). Sociedade Brasileira de Fonoaudiologia. Berneburg M, Zeyher C, Merkle T, Möller M, Schaupp E, Göz G. Orthodontic findings in 4-to 6-year-old kindergarten children from southwest Germany. Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie 2010; 1:71. Dimberg L, Lennartsson B, Arnrup K, Bondemark L. Prevalence and change of malocclusions from primary to early permanent dentition: a longitudinal study. The Angle Orthodontist. 2015 Aug 1;85(5):728-34. Chang MC, Chen HL, Huang ST, Wang HP, Liu HY. Relationship between orofacial dysfunction and orofacial features, oral function, and eating performance among preschool children. Journal of Dental Sciences. 2024 Apr 1;19(2):1044-51. Bishara SE, Warren JJ, Broffitt B, Levy SM. Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life. American Journal of Orthodontics and Dentofacial Orthopedics 2006; 130:31-6. Feldens CA, Martins RP, Maciel RR, Vargas-Ferreira F, Kramer PF. Factors associated with the occurrence of distoclusion in the primary dentition: a hierarchical analysis. Journal of Clinical Pediatric Dentistry. 2016 Jan 1;40(1):88-93 Ataseverİşler AA, Hezenci Y, Bulut M. Prevalence of orthodontic malocclusion in children aged 10–12: an epidemiological study. BMC Oral Health. 2025 Feb 18;25(1):249. Gomes MC, Neves ÉT, Perazzo MF, Martins CC, Paiva SM, Granville-Garcia AF. Association between psychological factors, socio-demographic conditions, oral habits and anterior open bite in five-year-old children. Acta Odontologica Scandinavica. 2018 Nov 17;76(8):553-8. Ferro R, Besostri A, Olivieri A, Quinzi V, Scibetta D. Prevalence of cross-bite in a sample of Italian preschoolers. Eur. J. Paediatr. Dent. 2016 Dec 1;17(1):307-9. Khda M, Kiliaridis S, Antonarakis GS. Spontaneous correction and new development of posterior crossbite from the deciduous to the mixed dentition. European journal of orthodontics 2023; 3:266-70. Germa A, Clément C, Weissenbach M, Heude B, Forhan A, Martin-Marchand L, Bonet M, Vital S, Kaminski M, Nabet C. Early risk factors for posterior crossbite and anterior open bite in the primary dentition. The Angle Orthodontist. 2016 Sep 1;86(5):832-8. Kirzioglu, Z., Simsek, S., & Yilmaz, Y. Longitudinal occlusal changes during the primary dentition and during the passage from primary dentition to mixed dentition among a group of Turkish children. European archives of paediatric dentistry: official journal of the European Academy of Paediatric Dentistry 2013:14: 97–103. Hegde S, Panwar S, Bolar DR, Sanghavi MB. Characteristics of occlusion in primary dentition of preschool children of Udaipur, India. European journal of dentistry 2012; 6:051-5. Barros SE, Chiqueto K, Janson G, Ferreira E. Factors influencing molar relationship behavior in the mixed dentition. American Journal of Orthodontics and Dentofacial Orthopedics 2015; 148:782-92. Bishara SE, Hoppens BJ, Jakobsen JR, Kohout FJ. Changes in the molar relationship between the deciduous and permanent dentitions: a longitudinal study. Am J Orthod Dentofacial Orthop. 1988 Jan;93(1):19-28. doi: 10.1016/0889-5406(88)90189-8. PMID: 3422119. da Silva LP, Gleiser R. Occlusal development between primary and mixed dentitions: a 5-year longitudinal study. Journal of Dentistry for Children 2008; 75:287-94. Kongo E, Gribizi I, Spahiu E, Gravina GM. Prevalence of malocclusion and oral health-related factors among pre-school children in Northern Albania. Journal of Clinical Pediatric Dentistry 2024: 1;48. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7261330","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493698682,"identity":"65041933-b677-4bac-bbf1-36a1ff681f31","order_by":0,"name":"Elona Kongo","email":"data:image/png;base64,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","orcid":"","institution":"Department of Dentistry, Faculty of Medical Science, Albanian University, Tirana, Albania","correspondingAuthor":true,"prefix":"","firstName":"Elona","middleName":"","lastName":"Kongo","suffix":""},{"id":493699010,"identity":"7db34935-911f-4eae-91db-5d0a241d5592","order_by":1,"name":"Busra Emir","email":"","orcid":"","institution":"Department of Biostatistics, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey","correspondingAuthor":false,"prefix":"","firstName":"Busra","middleName":"","lastName":"Emir","suffix":""},{"id":493699011,"identity":"67c37d6f-71c2-4243-bd2e-98e13cf20740","order_by":2,"name":"Ilda Gribizi","email":"","orcid":"","institution":"Department of Dentistry, Faculty of Medical Science, Albanian University, Tirana, Albania","correspondingAuthor":false,"prefix":"","firstName":"Ilda","middleName":"","lastName":"Gribizi","suffix":""},{"id":493699012,"identity":"a2379e49-6d27-4643-8936-c77ad29d4376","order_by":3,"name":"Beatrice Manes Gravina","email":"","orcid":"","institution":"Independent Researcher, Rome, Italy","correspondingAuthor":false,"prefix":"","firstName":"Beatrice","middleName":"Manes","lastName":"Gravina","suffix":""}],"badges":[],"createdAt":"2025-07-31 10:51:44","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7261330/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7261330/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88214978,"identity":"d1334efc-5483-4d0f-931f-e5b77fdc872b","added_by":"auto","created_at":"2025-08-04 06:38:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1134791,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7261330/v1/aff66fb3-7d3e-4768-a9e3-144aabc919df.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eInvestigating the Relationships Among Age, Occlusal Traits, and Malocclusion Severity in Preschool Children. A Cross-sectional Study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eEarly childhood is a particularly important stage, as it affects normal growth and development. During this stage, genetic or even environmental factors can affect growth and development, causing malocclusion [1]. Considering that oral health might be affected by malocclusion [2], oral health management, which aims to establish healthy dentition and alleviate or avoid malocclusion from the eruption of the first primary tooth to the accomplishment of young permanent dentition, is highly important in the pediatric population [3]. Hence, early detection of malocclusion traits and associated risk factors is crucial for restoring normal occlusal development and overall oral health [4,5]. Indeed, it has been suggested that the removal of risk factors impacts the prevalence and severity of existing malocclusion [6]. A prospective cohort study conducted among 3-year-old German children concluded that nonnutritive sucking habits were risk factors for the development of malocclusion [7]. Moreover, a recent study revealed that thumb/digit sucking habits contribute to masticatory difficulties [8]. Therefore, the management of oral functionality, which consists of the correction of poor oral habits, is among the objectives of early orthodontic treatment [9].\u003c/p\u003e\u003cp\u003eCertain features of primary dentition can contribute to malocclusion in permanent dentition. According to Ngan, among such conditions are early loss of primary teeth, mesioclusion or distoclusion, cross bite (CB), anterior open bite (AOB) and deep bite [10]. Additionally, class II occlusal characteristics,such as a Ds class II primary canine relationship and increased OVJ already present in the primary dentition during the transition to mixed dentition, are maintained or worsen [11]. A recent longitudinal study that monitored 5-year-old children revealed that the probability of presenting malocclusion in mixed dentition increases if CB and increased OVJ are present in the primary dentition stage [12]. Current evidence confirms that during the transition from temporary dentition to permanent dentition, various changes related to growth or environmental factors may occur [13, 14]. Therefore, continuous monitoring is recommended [6].\u003c/p\u003e\u003cp\u003eIn addition to dental health, psychosocial well-being and social well-being are disadvantages of malocclusion [9]. It is believed that maintaining good oral health throughout childhood not only provides a solid foundation for good oral function in adulthood but also has beneficial effects on the quality of life of families [15]. A cross-sectional epidemiologic study revealed that AOB was associated with a negative impact on quality of life among preschool children and their families [16]. Moreover, Sakaryalireported that only severe malocclusion had a statistically significant effect on children, but both simple and severe malocclusion had significantly negative effects on parents [17].\u003c/p\u003e\u003cp\u003eData regarding the prevalence and features of malocclusion among Albanian preschool children are limited. Thus, the aim of this study was to explore the associations of age and occlusal traits with the severity of malocclusion among preschool children attending public kindergartens in Tirana, the capital city of Albania.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis descriptive cross-sectional epidemiological study was conducted from October 2023May 2024. After permission was obtained from the local authorities, 18 kindergartens were randomly selected. Prior to the examinations, written informed consent was obtained from the parents as well. In addition to permission to visit the children, parents were also given a short questionnaire as described in a previous study [18].The children included in the study fulfilled the following criteria: 1) Albanian ethnicity; 2) 3–6 years old; 3) no oral syndromes/clefts; 4) no history of orthodontic treatment; and 5) present at the day of examination, with parental consent. The exclusion criteria were as follows: 1) refusal from parents and 2) non collaborative children.\u0026nbsp;The clinical data were collected from 2 orthodontic specialists, E.K. and I.G. (each with more than 10 years of clinical experience in orthodontics), on a specific form created for the present study.\u003c/p\u003e\n\u003cp\u003eThe number of necessary participants was 386 according to the formula n = z2 p(1-p)/e2;however, to assure the most similar participants for each age group, the final sample included 719 children.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Intraexaminer and interexaminer reliability was assessed using Cohen’s kappa coefficient via duplicate examinations of 30 children. The intraexaminer reliability yielded a kappa value of 0.82, indicating substantial agreement, while the interexaminer reliability resulted in a kappa of 0.74, reflecting moderate to substantial agreement.\u003c/p\u003e\n\u003cp\u003eThe dental examination was carried out in every kindergarten room under natural daylight with respect to infection control by using disposable examination gloves and sterile mouth mirrors and explorers. Occlusion was assessed while each child was biting on his or her posterior teeth with the jaws in a centric relationship (maximal intercuspation).\u003c/p\u003e\n\u003cp\u003eMalocclusion was recorded via a protocol proposed in previous similar studies [1, 14].\u003c/p\u003e\n\u003cp\u003eThe following occlusal traits were recorded:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePrimary molar relationship:\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eFlush terminal plane (Ftp): The distal surfaces of the maxillary and mandibular primary second molars were in the same vertical plane.\u003c/p\u003e\n\u003cp\u003eDistal step (Ds): The distal surface of the mandibular primary second molar was distal to that of the maxillary primary second molar.\u003c/p\u003e\n\u003cp\u003eMesial step (Ms): The distal surface of the mandibular primary second molar was mesial to that of the maxillary primary second molar.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePrimary canine relationship:\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026nbsp;Class I: The cusp tip of the maxillary primary canine tooth was on the same vertical plane as the distal\u003c/p\u003e\n\u003cp\u003esurface of the mandibular primary canine.\u003c/p\u003e\n\u003cp\u003eClass II: The cusp tip of the maxillary primary canine tooth was mesial to the distal surface of the mandibular primary canine.\u003c/p\u003e\n\u003cp\u003eClass III: The cusp tip of the maxillary primary canine tooth was distal to the distal surface of the mandibular primary canine.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;- Overjet (OVJ), expressed in mm, was measured from the midpoint of the labial surface of the most anterior lower central incisor to the midpoint of the labial surface of the most anterior upper central incisor. It was categorized as normal (0–3 mm) or increased (≥4 mm).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;- Overbite (OVB), expressed in mm, was measured as the vertical distance between the incisal edges of the upper and lower central incisors. It was categorized as follows: normal (0–50%), deep overbite (\u0026gt; 50%), or open bite.\u003c/p\u003e\n\u003cp\u003e- Anterior crossbite (ACB) was recorded as present when one or more of the maxillary incisors/canines occluded lingually relative to the mandibular incisors/canines.\u003c/p\u003e\n\u003cp\u003e-Posterior crossbite (PCB) was recorded as present when one or more of the maxillary molars occluded lingually to the mandibular molars.\u003c/p\u003e\n\u003cp\u003e-Scissor bite was recorded when maxillary molars occluded the buccal surfaces of the corresponding mandibular molars and/or mandibular molars occluded the lingual surfaces of the corresponding maxillary molars.\u003c/p\u003e\n\u003cp\u003eA child presenting one of more of the following altered occlusal traits was recorded as having malocclusion: class II or III canine relationship; Ds; increased OVJ; deep OVB\u0026gt;50%; or AOB, CB, ACB or PCB. Furthermore, children with malocclusion were analyzed according to the number of altered occlusal traits from 1-4.\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u003c/p\u003e\n\u003cp\u003eThe data were evaluated via the statistical package program IBM SPSS Statistics 25.0 (IBM Corp., Armonk, New York, USA). Categorical variables are presented as frequencies and percentages. The relationships between categorical variables were evaluated with the continuity correction test, Fisher’s exact test for \u003cem\u003e2\u003c/em\u003e ×\u003cem\u003e2\u003c/em\u003e tables and the Pearson chi-square test for\u003cem\u003er\u003c/em\u003e×\u003cem\u003ec\u003c/em\u003e tables. Binary logistic regression analysis and multivariable logistic regression analysis were used to determine the risk factors affecting a child’s malocclusion severity. As a result of the logistic regression analysis of risk factors, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated according to the reference category for each variable. A value of \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eRegarding the assumptions of logistic regression, we verified key model assumptions prior to analysis. Multicollinearity was assessed using variance inflation factors (VIF), with all covariates showing acceptable values (VIF \u0026lt; 2.5). The linearity of continuous covariates with the logit of the outcome was evaluated using the Box-Tidwell test, and no violations were detected. Furthermore, model fit was assessed using the Hosmer-Lemeshow goodness-of-fit test, which indicated adequate calibration (p \u0026gt; 0.05).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 719 children aged 3\u0026ndash;6 years (362 females and 357 males), with a mean age of 4.03 years, who met the inclusion criteria were included in the study. There were no differences in terms of age or sex distribution (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The prevalence of children without malocclusion was 43.7% (174 females and 140 males). More than half of the children with malocclusion had one type of malocclusion (116 females and 126 males). Only 8 children had 4 types of malocclusions. There were significant differences in terms of malocclusion severity and sex (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStatistical comparisons according to age, sex and malocclusion type.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;362)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;357)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99 (27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108 (30.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.639 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e138 (38.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e135 (37.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e125 (34.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e114 (31.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMalocclusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo malocclusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e174 (48.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e140 (39.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e116 (32.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126 (35.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 types\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (16.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63 (17.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 types\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (5.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 types\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (2.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e Pearson chi-square test,\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA comparison of occlusal traits according to age group is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cem\u003eMolar relationship\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFtp and Ms were more common in the 4-year-old group, with a minimal difference between sexes, but compared with the other age groups, the difference was significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020). The 3- and 4-year-old groups had similar frequencies of Ds, but the difference was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.576).\u003c/p\u003e\u003cp\u003e\u003cem\u003eCanine relationship\u003c/em\u003e\u003c/p\u003e\u003cp\u003eCompared with the other classes, class I malocclusion was more prevalent in boys (43/68\u0026thinsp;=\u0026thinsp;63.23%) than in girls in the 4-year-old group (p\u0026thinsp;=\u0026thinsp;0.013) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).The similar frequency between sexes (24) in the 5-year-old group was the highest for the class II canine relationship. A significant difference in the canine relationship was not observed between the groups.\u003c/p\u003e\u003cp\u003eThe frequency of increased OVJ\u0026thinsp;\u0026gt;\u0026thinsp;4 mm and OVB\u0026thinsp;\u0026gt;\u0026thinsp;50% was 15.4%, and OVJ\u0026thinsp;\u0026gt;\u0026thinsp;4 mm was more common in the 4-year-old group. There were no significant differences among the three groups in OVJ (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.733) or OVB (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.4497). The prevalence of AOB was 2.6%, which was greater among 5-year-old children. The prevalence of unilateral CB was 3%, which was similar among 3- and 5-year-old children. The bilateral CB prevalence was 1.2%, with a similar frequency in both sexes in 3-year-old children, whereas there were no male children with bilateral CB in the 2 other age groups. ACB was observed in 3.3% of the whole sample and was slightly more common among 5-year-old children. There were no significant differences in CB among the unilateral, bilateral (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.960) and anterior (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.168) groups.\u003c/p\u003e\u003cp\u003eIn terms of malocclusion severity, which was measured by how many types of altered occlusal parameters were observed in a child, our results indicate that there were more children with one type of malocclusion among the 4-year-old children (13.9%) than among the 5-year-old (10.8%) and 3-year-old (8.9%) children.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStatistical comparisons by age group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"13\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e3 Years\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e4 Years\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e\u003cp\u003e5 Years\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e (\u003cem\u003e%\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e (\u003cem\u003e%\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e (\u003cem\u003e%\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e (\u003cem\u003e%\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e (\u003cem\u003e%\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e (\u003cem\u003e%\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003cp\u003e(For\u003c/p\u003e\u003cp\u003eage group comparisons)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eMolar relationship\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFlush\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29 (29.3)\u003c/p\u003e\u003cp\u003e70 (70.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34 (31.5)\u003c/p\u003e\u003cp\u003e74 (68.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.732 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e51 (37.0)\u003c/p\u003e\u003cp\u003e87 (63.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e46 (34.1)\u003c/p\u003e\u003cp\u003e89 (65.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.619 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e55 (44.0)\u003c/p\u003e\u003cp\u003e70 (56.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e48 (42.1)\u003c/p\u003e\u003cp\u003e66 (57.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.768 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;+\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMesial step\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (78.8)\u003c/p\u003e\u003cp\u003e21 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e86 (79.6)\u003c/p\u003e\u003cp\u003e22 (20.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.94 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e97 (70.3)\u003c/p\u003e\u003cp\u003e41 (29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e101 (74.8)\u003c/p\u003e\u003cp\u003e34 (25.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.402 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e84 (67.2)\u003c/p\u003e\u003cp\u003e41 (32.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e80 (70.2)\u003c/p\u003e\u003cp\u003e34 (29.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.621 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;+\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistal step\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92 (92.9)\u003c/p\u003e\u003cp\u003e7 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e96 (88.9)\u003c/p\u003e\u003cp\u003e12 (11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.444 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e131 (94.9)\u003c/p\u003e\u003cp\u003e7 (5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e123 (91.1)\u003c/p\u003e\u003cp\u003e12 (8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.242\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;F\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e114 (91.2)\u003c/p\u003e\u003cp\u003e11 (8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e103 (90.4)\u003c/p\u003e\u003cp\u003e11 (9.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.998 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.576 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAsymmetric\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98 (99.0)\u003c/p\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e108 (100.0)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.478 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;F\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e135 (97.8)\u003c/p\u003e\u003cp\u003e3 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e135 (100.0)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.247 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e122 (97.6)\u003c/p\u003e\u003cp\u003e3 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e111 (97.4)\u003c/p\u003e\u003cp\u003e3 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.000\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;F\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.165 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eCanine relationship\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClass I\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (21.2)\u003c/p\u003e\u003cp\u003e78 (78.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30 (27.8)\u003c/p\u003e\u003cp\u003e78 (72.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.273 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25 (18.1)\u003c/p\u003e\u003cp\u003e113 (81.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e43 (31.9)\u003c/p\u003e\u003cp\u003e92 (68.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e30 (24.0)\u003c/p\u003e\u003cp\u003e95 (76.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e31 (27.2)\u003c/p\u003e\u003cp\u003e83 (72.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.572 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.975 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClass II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80 (80.8)\u003c/p\u003e\u003cp\u003e19 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85 (78.7)\u003c/p\u003e\u003cp\u003e23 (21.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.707 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e119 (86.2)\u003c/p\u003e\u003cp\u003e19 (13.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e102 (75.6)\u003c/p\u003e\u003cp\u003e33 (24.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e101 (80.8)\u003c/p\u003e\u003cp\u003e24 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e90 (78.9)\u003c/p\u003e\u003cp\u003e24 (21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.721 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.932 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClass III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97 (98.0)\u003c/p\u003e\u003cp\u003e2 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e101 (93.5)\u003c/p\u003e\u003cp\u003e7 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.218 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e135 (97.8)\u003c/p\u003e\u003cp\u003e3 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e126 (93.3)\u003c/p\u003e\u003cp\u003e9 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.082\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;F\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e120 (96.0)\u003c/p\u003e\u003cp\u003e5 (4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e107 (93.9)\u003c/p\u003e\u003cp\u003e7 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.645 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.927 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAsymmetric\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99 (100.0)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e108 (100.0)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e135 (97.8)\u003c/p\u003e\u003cp\u003e3 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e134 (99.3)\u003c/p\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.622\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;F\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e124 (99.2)\u003c/p\u003e\u003cp\u003e1 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e114 (100.0)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e3.94 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;F\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.143 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eOverjet\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal (0\u0026ndash;3 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (18.2)\u003c/p\u003e\u003cp\u003e81 (81.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21 (19.4)\u003c/p\u003e\u003cp\u003e87 (80.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.816 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16 (11.6)\u003c/p\u003e\u003cp\u003e122 (88.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26 (19.3)\u003c/p\u003e\u003cp\u003e109 (80.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.112 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e20 (16.0)\u003c/p\u003e\u003cp\u003e105 (84.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e23 (20.2)\u003c/p\u003e\u003cp\u003e91 (79.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.502 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.570 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncreased (\u0026ge;\u0026thinsp;4 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83 (83.8)\u003c/p\u003e\u003cp\u003e16 (16.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e89 (82.4)\u003c/p\u003e\u003cp\u003e19 (17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.784 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e123 (89.1)\u003c/p\u003e\u003cp\u003e15 (10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e111 (82.2)\u003c/p\u003e\u003cp\u003e24 (17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.145 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e107 (85.6)\u003c/p\u003e\u003cp\u003e18 (14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e95 (83.3)\u003c/p\u003e\u003cp\u003e19 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.760 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.733 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eOverbite\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNormal (0\u0026ndash;50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86 (86.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e88 (81.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.485 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e112 (81.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e107 (79.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.793 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e104 (83.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e92 (80.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.725 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.497 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDeep overbite (\u0026gt;\u0026thinsp;50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17 (15.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26 (19.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e18 (14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e17 (14.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAOB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2 (1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eCrossbite\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo CB\u003c/p\u003e\u003cp\u003eUnilateral PCB\u003c/p\u003e\u003cp\u003eBilateral CB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95 (96.0)\u003c/p\u003e\u003cp\u003e3 (3.0)\u003c/p\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e103 (95.4)\u003c/p\u003e\u003cp\u003e4 (3.7)\u003c/p\u003e\u003cp\u003e1 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.94 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e130 (94.2)\u003c/p\u003e\u003cp\u003e5 (3.6)\u003c/p\u003e\u003cp\u003e3 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e132 (97.8)\u003c/p\u003e\u003cp\u003e3 (2.2)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.235 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e116 (92.8)\u003c/p\u003e\u003cp\u003e5 (4.0)\u003c/p\u003e\u003cp\u003e4 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e112 (98.2)\u003c/p\u003e\u003cp\u003e2 (1.8)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.090 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.960 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eACB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97 (98.0)\u003c/p\u003e\u003cp\u003e2 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e107 (99.1)\u003c/p\u003e\u003cp\u003e1 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.939 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e133 (96.4)\u003c/p\u003e\u003cp\u003e5 (3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e130 (96.3)\u003c/p\u003e\u003cp\u003e5 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.000\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;F\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e120 (96.0)\u003c/p\u003e\u003cp\u003e5 (4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e108 (94.7)\u003c/p\u003e\u003cp\u003e6 (5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.761\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;F\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.168 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrodie\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99 (100.0)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e107 (99.1)\u003c/p\u003e\u003cp\u003e1 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.000\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;F\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e138 (100.0)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e134 (99.3)\u003c/p\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.495\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;F\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e125 (100.0)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e114 (100.0)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.745 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMalocclusion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo malocclusion\u003c/p\u003e\u003cp\u003e1 type\u003c/p\u003e\u003cp\u003e2 types\u003c/p\u003e\u003cp\u003e3 types\u003c/p\u003e\u003cp\u003e4 types\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48 (48.5)\u003c/p\u003e\u003cp\u003e34 (34.3)\u003c/p\u003e\u003cp\u003e13 (13.1)\u003c/p\u003e\u003cp\u003e2 (2.0)\u003c/p\u003e\u003cp\u003e2 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49 (45.4)\u003c/p\u003e\u003cp\u003e30 (27.8)\u003c/p\u003e\u003cp\u003e21 (19.4)\u003c/p\u003e\u003cp\u003e6 (5.6)\u003c/p\u003e\u003cp\u003e2 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.440 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e57 (41.3)\u003c/p\u003e\u003cp\u003e53 (38.4)\u003c/p\u003e\u003cp\u003e27 (19.6)\u003c/p\u003e\u003cp\u003e1 (0.7)\u003c/p\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e52 (38.5)\u003c/p\u003e\u003cp\u003e47 (34.8)\u003c/p\u003e\u003cp\u003e27 (20.0)\u003c/p\u003e\u003cp\u003e6 (4.4)\u003c/p\u003e\u003cp\u003e3 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.129 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e69 (55.2) \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e29 (23.2) \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e19 (15.2) \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e8 (6.4) \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e0 (0.0) \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e39 (34.2) \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e49 (43.0) \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e15 (13.2) \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e8 (7.0) \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e3 (2.6) \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e3.94 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.206 \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;\u003c/sup\u003e Pearson chi-square test, \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;C\u003c/sup\u003econtinuity correction test, \u003csup\u003e\u003cem\u003eX\u003c/em\u003e\u0026sup2;F\u003c/sup\u003e Fisher\u0026rsquo;s exact test.\u003c/p\u003e\u003cp\u003eThe flush distribution of the \u003csup\u003e+\u003c/sup\u003e 3- to 5-year-old age groups was statistically significant. Additionally, the mesial distribution of the 3-5-year-old age groups was statistically significant.\u003c/p\u003e\u003cp\u003eSuperscript \u003cem\u003ea\u003c/em\u003eand \u003cem\u003eb\u003c/em\u003eindicate a statistically significant difference.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors affecting a child\u0026rsquo;s risk of severe malocclusion according to binary logistic regression\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUnivariate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMultivariate\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.046\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.50 (1.18\u0026ndash;1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.62 (1.05\u0026ndash;2.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.030\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.21 (0.94\u0026ndash;1.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.05 (0.66\u0026ndash;1.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.821\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.55 (1.25\u0026ndash;1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft molar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlush\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMesial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.93 (0.70\u0026ndash;1.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.614\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.97 (0.65\u0026ndash;1.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.872\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.00 (5.08\u0026ndash;38.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.15 (2.70\u0026ndash;24.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight molar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlush\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMesial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.92 (0.70\u0026ndash;1.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.924\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.25 (5.17\u0026ndash;39.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsymmetrical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (0.29\u0026ndash;3.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlush\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.22 (1.02\u0026ndash;1.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.032\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMesial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.93 (0.70\u0026ndash;1.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.614\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.00 (5.08\u0026ndash;38.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft canine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.60 (11.31\u0026ndash;67.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.04 (4.67\u0026ndash;31.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.50 (3.71\u0026ndash;64.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.22 (1.13\u0026ndash;24.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight canine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.33 (10.31\u0026ndash;52.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.50 (3.71\u0026ndash;64.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCanine asymmetric\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.67 (0.11\u0026ndash;3.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.657\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCanine relationship 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.77 (0.65\u0026ndash;0.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.46 (0.32\u0026ndash;0.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCanine relationship 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34.50 (12.77\u0026ndash;93.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCanine relationship 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.50 (3.71\u0026ndash;64.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOVJ normal (0\u0026ndash;3 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.93 (0.79\u0026ndash;1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.346\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOVJ increased (\u0026ge;\u0026thinsp;4 mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.20 (8.65\u0026ndash;51.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.15 (5.87\u0026ndash;39.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eACB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.00 (1.19\u0026ndash;7.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.096\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo CB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUni\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.67 (1.04\u0026ndash;6.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.25 (0.77\u0026ndash;6.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.50 (0.73\u0026ndash;16.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.94 (0.73\u0026ndash;21.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOR odds ratio, CI confidence interval\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the binary logistic regression results. According to the univariate model results, independent variables were first considered separately. When the 3-year-old age group was used as a reference, the risk of severe malocclusion was 1.5 times greater than when the 4-year-old group was used as a reference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Males had a 1.55-fold greater risk than did females (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The Ds and canine class III relationships were associated with 14-fold (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 15.5-fold greater risks, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Increased OVJ was associated with 21.2 times greater than no increased OVJ (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Children with ACB were at 3 times greater risk of severe malocclusion than those without ACB (p\u0026thinsp;=\u0026thinsp;0.020). Those with unilateral PCB were 2.67 times more prone to severe malocclusion than those without (p\u0026thinsp;=\u0026thinsp;0.04). Multivariable logistic regression analysis including variables found to be significant on univariate logistic regression analysis was then performed, and a single model was created. Children in the 4-year-old group had a 1.62-fold greater risk of developing severe malocclusion than those in the 3-year-old group (OR (95% CI):1.62 (1.05\u0026ndash;2.50); \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030). Those with increased OVJ had a 15.15-fold greater risk of developing more severe malocclusion (OR (95% CI):15.15 (5.87\u0026ndash;39.09) \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe objective of this study was to explore the associations of age and occlusal traits with the severity of malocclusion among preschool children. In general, the results show that malocclusion is widespread and that severity is affected by age and occlusal traits.\u003c/p\u003e\u003cp\u003eThe current literature demonstrates a strong consensus on the high prevalence of malocclusion in preschool children [1, 4, 14, 19]. In addition to the agreement regarding prevalence, our study results are consistent with those of previous studies in terms of the most common type of malocclusion [1, 14, 20, 21]. In this study, the most frequent malocclusion types were increased OVJ and deep OVB, both with similar prevalence rates (15.4%). The prevalence observed among Saudi Arabian children was greater for both OVJ and OVB [14]. According to the authors, the disparity observed with data from the same population was attributed to differences in lifestyle, diet and maladaptive oral behaviors. The multivariate regression analysis revealed that children with increased OVJ had a 15.15-fold greater risk of developing more severe malocclusion (OR (95% CI):15.15 (5.87\u0026ndash;39.09) \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In this study, a cutoff point of \u0026gt;\u0026thinsp;4mm was used to identify increased OVJ, indicating a greater risk for dental trauma, especially if the increased OVJ is combined with incomplete lip closure [21]. Increased OVJ is the consequence of oral habits and is considered a risk factor for moderate and severe malocclusion [5,22]. Compared with other habits, thumb/digit sucking not only has an effect on malocclusion prevalence [7] but also significantly greater increases the prevalence of increased OVJ compared with a pacifier habit [23]. Moreover, a recent cross-sectional study among Brazilian preschoolers concluded that children who were never breastfed and used a pacifier had a higher prevalence of malocclusion [19]. According to Feldens \u003cem\u003eet al.\u003c/em\u003e bottle feeding is a risk factor for the discontinuation of breastfeeding and is also associated with pacifier use [24]. However, regardless of the particular type, oral habits can contribute to malocclusion and disrupt proper dental and jaw development [25, 26]. If a habit continues after the age of 4 years, there will be detrimental effects on occlusion at the age of 5 years [23].\u003c/p\u003e\u003cp\u003eResearch has revealed a correlation between age and the features of malocclusion within this age group. Findings suggest that the prevalence of malocclusion tends to decrease during growth [6, 13, 20, 27]. Indeed, the decrease in oral habits with increasing age suggests that functional improvement can lead to improvements in malocclusion [5, 24]. The regression analysis performed in this study revealed that children in the 4-year-old group had a 1.62-fold greater risk of developing severe malocclusion than those in the 3-year-old group (OR (95% CI):1.62 (1.05\u0026ndash;2.50); \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030). Thus, the increased risk of developing severe malocclusion in younger children noted in this study seems to be related to the reduced tendency to practice oral habits observed in older children [3, 6].\u003c/p\u003e\u003cp\u003eAnother distinct feature of malocclusion observed during the primary dentition stage is that certain types may resolve spontaneously [8, 13]. Knowledge of those malocclusion types that may exhibit spontaneous correction, such as CB, is important when planning early orthodontic treatment [28]. Of particular interest are the results of a French study involving 422 three-year-old children, which found PCB in 20% of the participants. The authors concluded that preterm birth and non-nutritive sucking habits are significant risk factors for the early development of PCB [29].\u003c/p\u003e\u003cp\u003eMoreover, if left untreated, CB may lead to the development of more severe malocclusion [28, 30]. Nevertheless, recent findings suggest that CB treatment should not be started before the eruption of the first permanent molar [28], perhaps except in exceptional cases with very asymmetrical facial growth [10]. In terms of the prevalence of CB, either ACB (3.3%) or PCB (3.05%), our results align with those of similar previous research [4, 27]. Although the prevalence is low, univariate model results indicate that children with ACB have a three-time greater risk of severe malocclusion than those without ACB (p\u0026thinsp;=\u0026thinsp;0.020). Similarly, children with unilateral PCB are at 2.67-times greater risk than those without PCB (p\u0026thinsp;=\u0026thinsp;0.040). These findings are consistent with the conclusions of a recent study, which suggested that children may develop PCB during the mixed dentition phase, even when a normal transverse relationship is observed in the deciduous dentition [11].\u003c/p\u003e\u003cp\u003eThe most prevalent primary molar relationship in this study was Ftp, which was observed in 63.4% of the included children. This result aligns with those of a previous study among Turkish children [4] but contradicts a prevalence reported among Saudi Arabian children [14]. We also found that the tendency for Ms increased with increasing age, which is also supported by previous studies [30, 31]. According to Barros [32], Ms was the most frequent terminal relationship of the primary second molars in mixed dentition, which produced an early and stable class I relationship for the permanent first molars. Moreover, considering that Bishara [33] suggested that slightly more than half of Ftp cases will progress to a normal class I molar relationship, it seems plausible to conclude that there is a slight increase in the likelihood of class I malocclusion. However, for an individual to be considered to have normal occlusion Ftp is not sufficient; other dental and skeletal parameters must also be considered [23]. In addition to the class I canine relationship, minimal OVJ and OVB may contribute to the proper transition to permanent dentition [34].\u003c/p\u003e\u003cp\u003eStudies have shown that certain features of primary dentition can serve as early indicators for the development of malocclusion in permanent dentition. For example, Bacetti [11] reported that the presence of a Ds molar relationship and increased OVJ in primary dentition are associated with the development of a class II molar relationship in permanent dentition. Similarly, Kirzioglu [30] \u003cem\u003eet al.\u003c/em\u003e reported that a class III canine relationship in the primary dentition can be a predictive factor for future malocclusion.\u003c/p\u003e\u003cp\u003eIn this study, children presenting with a class II or III canine relationship, along with Ds, increased OVJ, and increased OVB, were classified as having malocclusion. The results revealed that the presence of a distal step molar relationship and a class III canine relationship were associated with a 14-fold (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 15.5-fold (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) increased risk of developing malocclusion, respectively. These findings not only confirm the strong association between these altered occlusal traits and malocclusion but also reflect the severity of the condition when such features are present.\u003c/p\u003e\u003cp\u003eA comparison with a previous study [35] involving the same population of Albanian preschool children revealed discrepancies in the prevalence of certain malocclusion traits. Notably, a previous study revealed a greater prevalence of class III primary canine relationships (10.7% vs. 5.4%) and ACB (10.2% vs. 3.3%). These differences may be attributed to several factors, including variations in the protocols used to assess malocclusion, the larger sample size in the current study, and changes in the recruitment area. While the earlier study focused on children from the northern region of the country, the present study included participants from the capital. It is plausible that differences in socioeconomic conditions between regions may have contributed to the variation in malocclusion prevalence, as suggested by Gomes \u003cem\u003eet al\u003c/em\u003e. [26].\u003c/p\u003e\u003cp\u003eThis study has several limitations that should be acknowledged. First, the cross-sectional design limits causal inferences; observed associations do not imply cause-effect relationships. Therefore, while we report odds ratios as measures of association, these should not be interpreted as indicators of causality. This limitation is inherent to the study design and should be considered when interpreting the findings. Longitudinal research would be necessary to confirm causal pathways. A second limitation of this study is the unequal distribution of children across age groups, which was partly due to the limited number of fully completed parental questionnaires. Consequently, the study did not evaluate socioeconomic status or non-nutritive sucking habits, both of which are known to affect occlusal development. In addition, the exclusion of children attending private kindergartens may have introduced a degree of selection bias. Furthermore, children attending private kindergartens were not included, which may have introduced a degree of selection bias.\u003c/p\u003e\u003cp\u003eDespite these limitations, the study benefits from a robust sample size and offers valuable insights into the prevalence of malocclusion and associated variables in the primary dentition of Albanian children. Given the historical lack of preventive and interceptive strategies targeting malocclusions in this age group, the findings of this research are expected to be valuable to public health authorities. Nonetheless, further research is warranted to address the current study's limitations and to confirm its findings. Future studies should aim to assess the role of oral habits and include representative samples from all regions of Albania to provide a more comprehensive understanding of malocclusion patterns at the national level.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the results of this study demonstrate that an age of 4 years, an increased OVJ, a class III canine relationship and primary second molars in Ds are factors associated with the severity of malocclusion among preschool children.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of Albanian University (protocol code: 434;date of approval: 24/05/2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the parents.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by\u0026nbsp;Albanian University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003eConception of the study, E.K., I.G. and B.G.; collection of clinical data,E.K. and I.G.; data analysis and interpretation, B.E. and B.G.; writing\u0026mdash;original draft preparation, E.K.,I.G. and B.E. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Mrs. Enkeleda Isaku, Head\u0026nbsp;of theGeneral Directorate of Nurseries and Kindergartens, Tirana, Albania, and Dr. Aurela Fshati.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declare(s) no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOtsugu M, Sasaki Y, Mikasa Y, Kadono M, Sasaki H, Kato T, Nakano K. Incompetent lip seal and nail biting as risk factors for malocclusion in Japanese preschool children aged 3\u0026ndash;6 years. BMC pediatrics. 2023; 26; 23:532.\u003c/li\u003e\n\u003cli\u003eWorld Dental Federation. From Strictly Aesthetics to an Integral Part of Oral Health: A Brief History of Orthodontics through the Ages. 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Prevalence and risk indicators of primary dentition malocclusion in Riyadh-Saudi Arabia using a new case definition: A cross-sectional study. The Saudi Dental Journal 2024; 36:60-5.\u003c/li\u003e\n\u003cli\u003eRavaghi, V., Holmes, R., Steele, J. et al. The impact of oral conditions on children in England, Wales and Northern Ireland 2013. Br Dent J 2016:173\u0026ndash;178.\u003c/li\u003e\n\u003cli\u003eRamos-Jorge J, Motta T, Marques LS, Paiva SM, Ramos-Jorge ML. Association between anterior open bite and impact on quality of life of preschool children. Braz Oral Res 2015; 29:46.\u003c/li\u003e\n\u003cli\u003eSakaryali D, Bani ME, Cinar C, Alacam AL. Evaluation of the impact of early childhood caries, traumatic dental injury, and malocclusion on oral health\u0026ndash;Related quality of life for Turkish preschool children and families. Nigerian journal of clinical practice 2019; 22:817-23.\u003c/li\u003e\n\u003cli\u003eKongo, E., Gaҫe, E., Gravina, G.M. et al. Cross-bite and oral habits among Albanian autistic children according to the stages of occlusal development. Sci Rep 2024b; 24:70004-6\u003c/li\u003e\n\u003cli\u003ePegoraro ND, Santos CM, Colvara BC, Rech RS, Faustino-Silva DD, Hugo FN, Hilgert JB. Prevalence of malocclusion in early childhood and its associated factors in a primary care service in Brazil. InCoDAS 2021 Nov 22 (Vol. 34, p. e20210007). Sociedade Brasileira de Fonoaudiologia.\u003c/li\u003e\n\u003cli\u003eBerneburg M, Zeyher C, Merkle T, M\u0026ouml;ller M, Schaupp E, G\u0026ouml;z G. Orthodontic findings in 4-to 6-year-old kindergarten children from southwest Germany. Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie 2010; 1:71.\u003c/li\u003e\n\u003cli\u003eDimberg L, Lennartsson B, Arnrup K, Bondemark L. Prevalence and change of malocclusions from primary to early permanent dentition: a longitudinal study. 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BMC Oral Health. 2025 Feb 18;25(1):249.\u003c/li\u003e\n\u003cli\u003eGomes MC, Neves \u0026Eacute;T, Perazzo MF, Martins CC, Paiva SM, Granville-Garcia AF. Association between psychological factors, socio-demographic conditions, oral habits and anterior open bite in five-year-old children. Acta Odontologica Scandinavica. 2018 Nov 17;76(8):553-8.\u003c/li\u003e\n\u003cli\u003eFerro R, Besostri A, Olivieri A, Quinzi V, Scibetta D. Prevalence of cross-bite in a sample of Italian preschoolers. Eur. J. Paediatr. Dent. 2016 Dec 1;17(1):307-9.\u003c/li\u003e\n\u003cli\u003eKhda M, Kiliaridis S, Antonarakis GS. Spontaneous correction and new development of posterior crossbite from the deciduous to the mixed dentition. European journal of orthodontics 2023; 3:266-70.\u003c/li\u003e\n\u003cli\u003eGerma A, Cl\u0026eacute;ment C, Weissenbach M, Heude B, Forhan A, Martin-Marchand L, Bonet M, Vital S, Kaminski M, Nabet C. Early risk factors for posterior crossbite and anterior open bite in the primary dentition. The Angle Orthodontist. 2016 Sep 1;86(5):832-8.\u003c/li\u003e\n\u003cli\u003eKirzioglu, Z., Simsek, S., \u0026amp; Yilmaz, Y. Longitudinal occlusal changes during the primary dentition and during the passage from primary dentition to mixed dentition among a group of Turkish children. European archives of paediatric dentistry: official journal of the European Academy of Paediatric Dentistry 2013:14: 97\u0026ndash;103.\u003c/li\u003e\n\u003cli\u003eHegde S, Panwar S, Bolar DR, Sanghavi MB. Characteristics of occlusion in primary dentition of preschool children of Udaipur, India. European journal of dentistry 2012; 6:051-5.\u003c/li\u003e\n\u003cli\u003eBarros SE, Chiqueto K, Janson G, Ferreira E. Factors influencing molar relationship behavior in the mixed dentition. American Journal of Orthodontics and Dentofacial Orthopedics 2015; 148:782-92.\u003c/li\u003e\n\u003cli\u003eBishara SE, Hoppens BJ, Jakobsen JR, Kohout FJ. Changes in the molar relationship between the deciduous and permanent dentitions: a longitudinal study. Am J Orthod Dentofacial Orthop. 1988 Jan;93(1):19-28. doi: 10.1016/0889-5406(88)90189-8. PMID: 3422119.\u003c/li\u003e\n\u003cli\u003eda Silva LP, Gleiser R. Occlusal development between primary and mixed dentitions: a 5-year longitudinal study. Journal of Dentistry for Children 2008; 75:287-94.\u003c/li\u003e\n\u003cli\u003eKongo E, Gribizi I, Spahiu E, Gravina GM. Prevalence of malocclusion and oral health-related factors among pre-school children in Northern Albania. Journal of Clinical Pediatric Dentistry 2024: 1;48.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"malocclusion, occlusal traits, preschool children","lastPublishedDoi":"10.21203/rs.3.rs-7261330/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7261330/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The aim of this cross-sectional epidemiological study was to explore the associations of age and occlusal factors with the severity of malocclusion among preschool children attending public kindergarten in Tirana, the capital city of Albania.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eClinical data regarding malocclusion traits were collected from October 2023-May 2024 by examining 3- to 6-year-old children who were frequenting 18 randomly selected public kindergartens in Tirana, Albania. A child presenting one of the following altered occlusal traits was recorded as having malocclusion: class II or III canine relationship, distal step (Ds), increased overjet (OVJ), deep overbite (OVB) \u0026gt;50% or anterior open bite (AOB), cross bite (CB) either anterior (ACB) or posterior (PCB). The relationships between categorical variables were evaluated with the continuity correction test, Fisher’s exact test for 2 ×\u003cem\u003e2\u003c/em\u003e tables and the Pearson chi-square test for\u003cem\u003er\u003c/em\u003e×\u003cem\u003ec\u003c/em\u003etables. Binary logistic regression analysis and multivariable logistic regression analysis were used to determine the risk factors affecting a child’s malocclusion severity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 719 children aged 3–6 years (362 females and 357 males) with a mean age of 4.03 years who met the inclusion criteria were included in the study. There were no differences in terms of age or sex. The OVJ frequency and incidence of deep OVB\u0026gt;50% were 15.4%, and deep OVB was more common in the 4-year-old group. The incidence of AOB was 2.6%, which was greater among 5-year-old children. The multivariate regression analysis revealed that children in the 4-year-old group had a 1.62-fold greater risk of developing severe malocclusion (OR (95% CI):1.62 (1.05–2.50); \u003cem\u003ep\u003c/em\u003e=0.030). Those with increased OVJ had a 15.15-fold greater risk of developing more severe malocclusion (OR (95% CI):15.15 (5.87–39.09) \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe results of this study demonstrate that an age of 4 years, increased OVJ, a class III canine relationship and primary second molars in Ds are factors associated with the severity of malocclusion among preschool children.\u003c/p\u003e","manuscriptTitle":"Investigating the Relationships Among Age, Occlusal Traits, and Malocclusion Severity in Preschool Children. 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