Frequencies of Clinically Significance Tooth Size Discrepancies Among Different Ethnicity in Malaysia

Frequencies of Clinically Significance Tooth Size Discrepancies Among Different Ethnicity in Malaysia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Frequencies of Clinically Significance Tooth Size Discrepancies Among Different Ethnicity in Malaysia Aida Nur Ashikin Abd Rahman, Siti Adibah Othman, Anand Marya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1911101/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Aug, 2023 Read the published version in BMC Oral Health → Version 1 posted 10 You are reading this latest preprint version Abstract Background : The Bolton analysis is one of the commonly used tooth size analysis or diagnostic tools in deriving a treatment plan for orthodontic patient. Many studies have indicated and concluded that normal measurements for one group should not be considered normal for other ethnic groups. The aims and objectives of this study were to investigate the applicability of Bolton’s ratios in orthodontic population of Malaysian main ethnics; Malay, Chinese and Indians. Comparisons were made in term of size and distribution of tooth size discrepancy in Malaysian orthodontic population and the findings were converted in terms of millimetres. Methods : Hundred fifty pre-orthodontic study casts comprised of 52 Malay, 54 Chinese and 44 Indian patients were selected. Digital callipers (Fowler Pro-Max) link to Hamilton Tooth Arch Software were used to measure the tooth width and ratios. Statistical analysis was carried out to test for gender differences (independent t- test), to identify the effects of malocclusion and ethnic groups (Two-way ANOVA) and to compare the means of current study with Bolton’s standards (one sample t -test). Results : This study showed that there was no significant difference between genders of sample of each ethnic. There was no correlation found between ethnic groups and malocclusion classes. There was a significant difference when comparing Bolton values with Malay sample for both ratios. It was found that more Malay subjects presented with maxillary excess contrary to Chinese and Indian which presented more maxillary deficiency for the anterior and overall ratio. Conclusion : there were 20.7% of Malaysian sample fall beyond suggested 2SD of clinically significant for anterior ratio and 4.7% which fall in this definition for overall ratio. The Bolton standards can be applied to Malaysian Chinese and Indians but not to Malays ethnic group. Subsequently, a specific standard should be used for the Malays orthodontic population. Tooth size discrepancy Bolton analysis Malaysian anterior ratio overall ratio. Figures Figure 1 Figure 2 Figure 3 Figure 4 Background The Bolton analysis is one of the commonly used tooth size analysis or diagnostic tools in deriving a treatment plan for orthodontic patient. However, Bolton [ 1 ] had carried out the study in 55 excellent occlusion cases among Caucasians. From his study, he formulated that overall ratio of 91.3 (± 1.91%) and anterior ratio of 77.2 (± 1.65%) will achieve a good interdigitation with good occlusion. Abd-Rahman and Othman [ 2 ] stated that numerous studies have indicated that normal measurements for one ethnic group should not be considered normal for other ethnic groups. A possible indication for population-specific standards are necessary for clinical assessments of each population, namely the Malaysian population. Studies carried out to Asian population which also demonstrated differences among malocclusion groups among southern Chinese children in Hong Kong [ 3 ] and Japanese orthodontic population [ 4 , 5 ] have suggested a different standard than Bolton’s although a study done among Class I Singaporean Chinese found a comparable result with Bolton’s standard [ 6 ]. Previous studies have shown that tooth size ratios are ethnicity, and sex-specific and that populations differ with respect to interarch tooth-size relationships, and differences in tooth sizes [ 7 – 12 , 5 ]. Tooth size exhibits a continuous range of variation among individuals and between populations. The variation in tooth size is influenced by genetic, environmental factors, ethnicity and gender. Several studies have demonstrated that mesiodistal crown diameters of males are larger than females [ 7 ] but however, this does not mean that they have larger tooth size ratios or an increased prevalence of tooth size discrepancies (TSD) [ 12 ]. The high prevalence of TSD in orthodontic population in relative to the general population has been well documented [ 12 – 13 ]. Findings of the norms will be a guide in determining the TSD in orthodontic populations that require orthodontic treatment. These values will be in turn converted in millimeters for decision in the treatment planning whether interproximal approximation is required for arch coordination and ideal interdigitation or reduction in tooth structures or even extractions as an option if severe TSD are present. The second part of Bolton’s study [ 14 ] described the clinical application of a tooth size analysis. Clinical application was discussed in depth in term of calculation of the arch length comparisons and determination of TSD in millimeters. The overall ratio was calculated from the summed of the greatest mesiodistal measurements of the teeth in each arch from first molar to first molar. The anterior ratio was calculated from the summed of the greatest mesiodistal measurements of the six anterior teeth in each arch. Applications of Bolton Analysis The value of correction in millimetres can be taken from the data collection sheet or calculated. Total corrections of anterior and overall ratios were calculated using a given formula and converted in term of millimetres. Bolton ratios were calculated in term of millimetres by employing the Bolton’s anterior and overall ratios’ formula and subtracting the solution from the existing summations of mesiodistal width of upper or lower teeth. The formula then further simplified and applied for accurate calculations in the SPSS as shown below; Upper correction (mm) = (Sum of maxillary “6” teeth) – [(Sum of mandibular “6” teeth) ÷ 0.772] Lower correction (mm ) = (Sum of mandibular “6” teeth) – [(sum of maxillary “6” teeth) × 0.772] Upper correction (mm) = (Sum of maxillary “12” teeth) – [(Sum of mandibular “12” teeth) ÷ 0.913] Lower correction (mm) = (Sum of mandibular “12” teeth) – [(sum of maxillary “12” teeth) × 0.913] Methods Aims of the study To compare the mean of anterior and overall ratios among the 3 majority ethnic groups in Malaysia; Malay, Chinese and Indian. To compare the mean of anterior and overall ratios with Bolton’s original study. To investigate the size and distribution of TSD in the Malaysian orthodontic population and convert the findings in terms of millimeters. Sample Selection Determined sample size of pretreatment study casts from each ethnic of who have sought orthodontic treatment in Dental Faculty, University of XXXX were selected. The estimation of sample size was calculated by running the G*Power software version 3.197. One hundred and fifty patients with 300 study casts were obtained that fit the inclusion and according to the sample size calculation of minimum 120 samples (40 samples for each ethnic) to satisfy the power of study of 0.8, (α = 0.05; β = 0.2) which consisted of 54 Chinese, 52 Malays and 44 Indians. Selection Criteria Inclusion criteria; Malay, Chinese, and Indian ethnicity. Ethnicity determinations were according to their name and race in the registration form and interview conducted to patients and parents. Fully erupted and complete permanent dentitions from first molar to contralateral first molar. Good quality pretreatment study casts. Exclusion criteria; Clinically visible dental caries, proximal restorations (Class II amalgam or composite), build ups, crowns and onlays that affect the tooth’s mesiodistal diameter. Congenital defects or deformed teeth. Obvious interproximal or occlusal wear of teeth. Previous or ongoing orthodontic treatment. Patient who came from mixed race and intermarriage. Data Collection Measurements of the greatest mesiodistal width of each tooth were taken with the caliper’s tips held perpendicular to the long axis of each tooth from the first molar to the first molar of each cast. The mesiodistal widths from the contact points of canine to canine for anterior ratio and first molar to first molar for overall ratio ( Fig. 1 ) were measured on each cast to the nearest 0.01mm, by using digital calipers (Fowler Pro-Max Calipers) linked to Hamilton Arch Tooth System software (HATS). The HATS software will calculate the anterior and overall ratio of each pair of orthodontic study cast using Bolton analysis. The tooth size corrections will also be calculated by the HATS software. The readings were recorded in the data collection sheet for further statistical management. Reliability and Reproducibility of the Measurements Two pairs of dental casts selected above were measured by one inter-examiner for data calibration as a gold standard using reliability analysis and intra class correlation by expertise in the field for measurement calibration. A high correlation of 0.994 between the principle investigator and the reference investigator was achieved. For intra-examiner reliability analysis, ten pairs of dental casts were randomly selected systematically by randomization using Statistical Package for the Social Sciences (SPSS) software. Each cast was measured at two separate occasions in two weeks’ interval by the principle investigator. The paired-sample t -test was used to evaluate the systematic error, and there was no statistically significant systematic error noted with p > 0.5. Our finding shows a very high correlation of Alpha Cronbach’s 0.995 between the first and second measurements and indicates that examiner was highly consistent in the measurement of the parameter. Statistical Analysis Skewness test shows data to be within 0 ± 2 which is within normal data distribution range. Kolmogorov-Smirnov test of normality was also carried out for every ethnic group and showed no statistic significant ( p > 0.05), hence data normality was assumed and further parametric test were carried out. Independent t- test was carried out to test for gender differences, two-way ANOVA to identify the effects of malocclusion and ethnic groups and one-sample t -test to compare the means of current study with Bolton’s standards. The data collected from the records were evaluated to determine the percentage of patients who had TSDs which were within one, within two, or greater than two standard deviations from Bolton's mean. A mean, median, range, standard deviation, standard error of the mean, and coefficient of variation were calculated for both the overall "12" ratio and anterior "6" ratio. Two-way analyses of variance (ANOVA) were used to correlate the interactions between ethnic and anterior ratio and overall ratio. Applications of Bolton Analysis The value of correction in millimeters was calculated. Total corrections of anterior and overall ratios were calculated using a given formula and converted in term of millimeters. Bolton ratios were calculated in term of millimeters by employing the Bolton’s anterior and overall ratios’ formula and subtracting the solution from the existing summations of mesiodistal width of upper or lower teeth. Results From Table 1 it was found that there was no gender difference found ( p > 0.05) within combination samples, and within all ethnicity for female and male and for anterior and overall ratios. Further statistical analyses were carried out without splitting the gender. A consistent trend of relatively higher mean was observed in male subject compared to female subjects in both anterior and overall ratio among all ethnic groups. However, these differences were not of statistically significant. Table 1 Independant t- test between gender among Malaysian and different ethnic group Variables Mean (SD) Mean (SD) Mean Difference P value Malaysian (n = 150) Male (n = 47) Female (n = 103) Anterior 77.85 (2.56) 77.32 (2.61) 0.53 0.243 Overall 91.71 (1.79) 91.28 (1.95) 0.43 0.207 Malay (n = 52) Male (n = 13) Female (n = 39) Anterior Ratio 78.45 (1.93) 78.29 (2.30) 0.16 0.821 Overall Ratio 92.73 (1.22) 91.99 (1.63) 0.74 0.138 Chinese (n = 54) Male (n = 15) Female (n = 39) Anterior Ratio 76.84 (1.93) 76.42 (2.66) 0.42 0.577 Overall Ratio 91.38 (1.37) 90.64 (2.16) 0.74 0.142 Indian (n = 44) Male (n = 19) Female (n = 25) Anterior Ratio 78.25 (3.17) 77.21 (2.54) 1.04 0.237 Overall Ratio 91.26 (2.16) 91.18 (1.75) 0.08 0.891 From Table 2 , there were statistical differences found between ethnicity but no interaction found between ethnicity and malocclusion types in the anterior ( p = 0.186) or overall ratios ( p = 0.073) from two-way ANOVA analyses. Statistical difference was found between ethnicity and post-hoc test was carried out. Table 2 Two-way ANOVA of anterior and overall ratios Variables F -statistic (df) p value Anterior ratio Ethnicity 9.93 (2) 0.000* Malocclusion 1.16 (2) 0.290 Ethnicity*Malocclusion 1.57 (4) 0.186 Overall ratio Ethnicity 8.73 (2) 0.000* Malocclusion 2.29 (2) 0.083 Ethnicity*Malocclusion 2.19 (4) 0.73 * statistically significant Table 3 shows one sample t -test was used to test the applicability of Bolton’s value to Malaysian samples. It was found that there was no significant difference found between the two groups with p = 0.177 of anterior ratio and p = 0.453 for overall ratio with means of 77.49(± 2.59) and 91.42(± 1.90) respectively for Malaysian samples. Using Pearson’s correlation analysis, it was found that the correlation between anterior and total tooth width ratios was moderate (Pearson’s correlation 0.665, P < 0.001 ( Fig. 2 ). Table 3 Comparison of anterior and overall ratios between Malaysian majority ethnics and Bolton standards Anterior Ratio Overall Ratio Ethnic Malay Chinese Indian Malaysian Malay Chinese Indian Malaysian n 52 54 44 150 52 54 44 150 Mean (SD) 78.33 (2.19) 76.53 (2.47) 77.66 (2.84) 77.49 (2.59) 92.18 (1.56) 90.85 (1.99) 91.22 (1.91) 91.42 (1.90) Mean Range 76.14–80.52 74.06-79.00 74.82–80.50 74.90- 80.08 90.62–93.74 88.86–92.84 89.31–93.13 89.52- 93.32 Bolton (SD) 77.20 (1.65) 91.30 (1.91) P value 0.000* 0.052 0.289 0.177 0.000* 0.101 0.777 0.453 * statistically significant Means of Malaysian anterior and overall ratios compare favorably to the Bolton standards with no statistically significant difference shown. Hence, Bolton’s ratios are applicable to overall Malaysian samples in combination. In the same table, comparing Malay’s samples and Bolton’s standard, showed highly significant differences between the Malay anterior ratio ( p = 0.000) and overall ratio ( p = 0.000) which suggest non applicability of Bolton’s value to Malay ethnic. However, Bolton ratios are found not to have any statistically significant differences when compared with the Chinese and Indians anterior and overall ratios as shown in Table 3 with p = 0.052 and p = 0.289 for anterior ratio and p = 0.101 and p = 0.777 for overall ratio in Chinese and Indian subjects respectively. Mean range of Malay subjects are found to be on the higher limit and beyond of Bolton’s range of both anterior and overall ratios. For anterior ratio, mean range for Malay ethnic group, are between 76.14 to 80.52 compared to Bolton’s value between 75.55 to 78.85. For overall ratio of Malay ethnic group, the mean ranging from between 90.62 to 93.74 compared to Bolton’s value between 89.39 to 93.21 ( Table 3 ) . For overall ratio ( Table 4 ) , more Malaysian patients in combination requiring addition of maxillary teeth due to maxillary deficiency (16%) and lowest percentage presented at the mandibular region for mandibular excess (12%). More Malay subjects present with maxillary excess (15.4%) and least percentage of subjects present with either mandibular excess in this group (1.9%). Contrary to findings in Malay ethnic group, more subjects presented with maxillary deficiency with 20.4% in Chinese and 11.4% in Indian respectively. However, least percentage of subjects presented with maxillary excess in Chinese (3%) as compared to Indian which have the least mandibular excess problem (4.5%) similarly as found in Malay. Table 4 Percentage of subjects with clinically significant tooth-width discrepancies larger than 2.0mm according to ethnic group Low-range proportion High range proportion Mandibular deficiency Maxillary excess Mandibular excess Maxillary deficiency Anterior ratio Malay 11.5% 15.4% 1.9% 3.8% Chinese 3.7% 3% 5.6% 20.4% Indian 9.1% 9.1% 4.5% 11.4% Malaysian 8% 9.3% 4% 12% Overall ratio Malay 19.2% 19.2% 1.9% 5.8% Chinese 11.1% 13% 24.1% 27.8% Indian 11.4% 11.4% 9.1% 13.6% Malaysian 14% 14.7% 12% 16% Table 5 – 6 and Fig. 3 – 4 illustrate the percentage of upper and lower correction in millimetres for both anterior and overall ratios of each ethnic group. There were mixed combinations of upper and lower corrections required to match the Bolton ratios. Table 5 show the percentages of Malaysian subjects in terms of the upper and lower corrections in millimetres which would be required to give the mean ratio for Bolton’s original sample. In these figures, a positive (+) sign on the x axis indicates that the correction to be done is to increase the tooth structure - relative tooth size deficiency, whereas the negative (-) sign indicates that the required correction is to reduce the tooth structure - relative tooth excess. For overall ratio as shown in Table 6 , more subjects from Malay ethnic group presented with maxillary excess and mandibular deficiency with the equal percentage of 19.2%. In Chinese, maxillary deficiencies and mandibular excess are the main problems observed with 27.8% and 24.1% of subjects respectively requiring either maxillary tooth addition or mandibular tooth structure reduction. In Indian ethnic group, almost similar finding with Chinese, more subjects presented with maxillary deficiency (13.6%) followed by mandibular deficiency and maxillary excess in 11.4% of samples respectively. Small percentage of subjects presented with mandibular excess consisting of 9.1% which would require mandibular tooth structure reduction or enamel stripping to obtain occlusal fit. Table 5 Percentage of subjects according to ethnicity requiring upper and lower anterior correction Correction Upper anterior Lower anterior (mm) Malay (%) Chinese (%) Indian (%) Malaysian (%) Malay (%) Chinese (%) Indian (%) Malaysian (%) <-2 15.4 3.7 9.1 9.3 1.9 5.6 4.5 4 -2 to -1.5 11.5 3.7 15.9 10 1.9 14.8 6.8 8 -1.5 to -1 13.5 7.4 6.8 9.3 0 11.1 6.8 6 -1 to -0.5 11.5 14.8 11.4 12.7 9.6 13 11.4 11.3 -0.5 to 0 15.4 18.5 13.6 16 19.2 7.4 13.6 13.3 0 to 0.5 15.4 7.4 11.4 11.3 17.3 24.1 18.2 20 0.5 to 1 9.6 9.3 9.1 9.3 17.3 13 9.1 13.3 1 to 1.5 3.8 11.1 9.1 8 17.3 7.4 18.2 14 1.5 to 2 0 3.7 2.3 2 3.8 0 2.3 2 > 2 3.8 20.4 11.4 12 11.5 3.7 9.1 8 Table 6 Percentage of subjects according to ethnicity requiring upper and lower overall correction Correction Upper overall Lower overall (mm) Malay (%) Chinese (%) Indian (%) Malaysian (%) Malay (%) Chinese (%) Indian (%) Malaysian (%) <-2 19.2 13 11.4 14.7 1.9 24.1 9.1 12 -2 to -1.5 15.4 5.6 4.5 8.7 3.8 5.6 11.4 6.7 -1.5 to -1 13.5 3.7 11.4 9.3 5.8 5.6 15.9 8.7 -1 to -0.5 11.5 11.1 15.9 12.7 9.6 9.3 9.1 9.3 -0.5 to 0 15.4 7.4 2.3 8.7 3.8 14.8 9.1 9.3 0 to 0.5 3.8 11.1 9.1 8 15.4 7.4 6.8 10 0.5 to 1 9.6 13 9.1 10.7 13.5 13 15.9 14 1 to 1.5 3.8 5.6 13.6 7.3 17.3 3.7 9.1 10 1.5 to 2` 1.9 1.9 9.1 4 9.6 5.6 2.3 6 > 2 5.8 27.8 13.6 16 19.2 11.1 11.4 14 Discussion TSD and Ethnicity In this study, in reflection of Bolton’s standard, the results show that Malay subjects have a significantly greater prevalence TSD than the Chinese or the Indians. Table 2 show that there was a very high significant interaction between ethnic group of the anterior ratio and overall ratio ( p = 0.000). Post hoc test described that there is significant difference observed in anterior ratio between Malay and Chinese subjects ( p = 0.001) and also very high significant differences in overall ratio between Malay and Chinese ( p = 0.001) and between Malay and Indian ( p = 0.029). In comparison of Bolton standards with Malaysian subjects ( Table 3 ) , Malaysian subjects do not show significant difference in both anterior and overall ratios. However, when comparing the ethnic groups in this study with the Bolton findings, it was found that Malay subjects show a highly statistical and clinically differences ( p = 0.000) in both anterior and overall ratios. Because the type of malocclusion does not predispose a patient to a TSD problem, the differences between our results of Malay mean and Bolton’s cannot be explained by the orthodontic samples used. Bolton’s anterior and overall ideal ratios were significantly smaller than of the estimates in the current study of Malay subjects, except those for Chinese and Indian subjects. This explained the fact that Bolton’s original sample which has been composed primarily of Caucasian samples and implies that the Bolton ratio is only applicable to Malaysian in general but it is not applicable to Malay population in particular. A few other similar studies are in agreement with the findings of the present study, indicating specific tooth size standard for their populations; Spanish [ 15 ], Japanese [ 11 ], and Iranian-Azari [ 16 ] of both the anterior and overall ratios. Ta et al., [ 3 ] found that Bolton’s standard is only applicable to their Class I occlusion of Southern Chinese but not to those of Class II and Class III occlusion. Whilst Smith et al., [ 17 ] who studied was on Bolton’s applicability on three populations; Black, Hispanics and White, found that Bolton ratios apply to white females only; the ratios should not be indiscriminately applied to white males, blacks, or Hispanics. They also concluded that interarch tooth size relationships are population and gender specific. In this study we found no significant difference for gender (Table 1 ). Frequencies of Bolton TSD Proffit [ 18 ] quoted that prevalence of TSD in the general population as being 5%. Othman and Harradine [ 19 ] noted that the basis for this prevalence was not explained and maybe defined as the proportion of cases that will fall outside 2SD from Bolton’s mean ratios. Based on this definition, sample of this study consist of 20.7% of anterior ratio TSD and 4.7% prevalence of overall ratio TSD. It was found to vary among different findings of different populations. There was higher incident of Malaysian subjects that fall beyond 2SD of Bolton anterior ratios as compared to overall ratio. Our findings are in agreement as that found by Crosby and Alexander [ 20 ] when comparing (3–3) anterior and (6–6) overall ratios, the authors found that in every malocclusion group, there is a greater percentage of patients with anterior mesial-distal TSD greater than 2SD from Bolton’s mean as compared with patients with overall discrepancies. The higher prevalence of anterior TSD seems to be quite agreeable to most authors [ 8 , 20 – 23 ]. This is true whether we are looking at maxillary or mandibular tooth size excesses and results from the present study are in agreement with findings from Crosby and Alexander [ 20 ]. This could be explained by the fact that anterior teeth, especially incisors, have a much greater incidence of tooth size deviations. The greatest variables in mesio-distal tooth width occur in the anterior region. In the study, it remains questionable which deviations of the overall and anterior values proposed by Bolton affect the final treatment outcome. Peg shaped lateral incisors are easily detected and express most often as TSD. Smith et al. [ 17 ] has similarly suggested that maxillary lateral incisors have previously been shown to be quite variable in size and are frequently the reason for a TSD between arches. And in this matter, aesthetic correction (crowns, veneers, etc) is often the first choice of treatment. Hidden TSD from a generalized discrepancy in tooth width between upper and lower teeth is less detectible at first sight and may cause a less favorable treatment outcome. Because the present sample consisted of patients who were in the orthodontic waiting list with high orthodontic treatment need, the presence of a larger percentage of TSD than that in Bolton’s sample seem reasonable. It is possible that the population of patients may be more diverse in the city of Kuala Lumpur with high migration rate from all over the country concentrated in the capital of Malaysia of which majority of the center’s orthodontic patients came from. Thus, the findings of this study may also represent the whole population in the country. It would seem logical that the percentage of patients that present with TSD may be somewhat dependent on the selection process or the characteristics of the population from which the subjects are drawn as observed in this study. Discrepancy in Millimetres as a Measure of Clinical Significance Threshold of 2 standard deviations (SD) of Bolton’s mean ratios as clinically significance have been well accepted and documented [ 8 , 19 – 22 , 24 ]. In this present study, 20.7% of Malaysian samples fall beyond the suggested clinically significant 2 SD. The three ethnics displayed similar trend out of their sample which fell beyond the 2 SD (19.2% of Malay, 20.4% of Chinese, 22.8% of Indians) as shown in Table 4 . This figures of clinically significant are in agreement as reported by other studies [ 19 ] but the incidence of overall ratio that fall beyond 2SD in current study are found to be less in combined samples of Malaysian, in Malay and in Chinese sample than reported by this author which are between 5–14%. In this study, it was found that our sample displayed a lesser percentage of standard deviations of overall ratio in 1.9% in Malay and 3.7% in Chinese but a comparable amount as reported by [ 19 ] of 4.7% in Malaysian sample and 9.1% in Indian. Endo et al. [ 24 ] mentioned the importance of TSD expressed in terms of both percentage and amount of millimetres required for correction. The authors quoted ‘ratios outside 2SD and TSD requiring more than 2 mm of maxillary and/or mandibular corrections are recommendable as the appropriate thresholds for clinical significance’. Othman and Harradine [ 19 ] had raised the issue of the fundamental of an absolute size of discrepancy thought to be incompatible with an acceptable occlusal fit. Proffit suggested that 1.5 mm as a cut-off point to be clinically significant [ 25 ]. This has been accepted by Bernabe et al., [ 8 ] in his study as their limit of acceptable discrepancy. A TSD of less than 1.5mm is rarely significant, but larger discrepancies create treatment problems and must be included in the orthodontic problem list at treatment planning stage [ 25 ]. In the current study, subjects requiring more than 2.0 mm corrections of either arches were considered of clinically significant as recommended by recent studies [ 19 , 24 ] as a threshold for clinically significant TSD. Table 4 – 5 shows that for anterior ratio in Malaysian combined sample, higher percentage of corrections are required for maxillary deficiency (12%), indicating build ups or permanent prosthesis for increase tooth width and less correction required for mandibular excess (4%) hence tooth structure reduction like interproximal stripping are advocate. Bernabe˘ and coworker [ 8 ] stated that the frequency of subjects with clinically significant TSD differs based on which arch is considered “normal”. If mandibular tooth-width is defined as normal, a tooth discrepancy would be described as a maxillary tooth-width deficiency or excess. From Table 4 illustrating percentage of subjects with clinically significant tooth-width discrepancies larger than 2.0 mm of Malaysian samples, it was found that in anterior as well as overall ratio, more subjects possessed a maxillary excess than other problems. However, from Table 5 and Table 6 , illustrating the clinically significant tooth width discrepancies according to ethnic group, it was found that Malay subjects present with more problem located in the maxillary arch due to maxillary excess in both anterior (26.9%) and overall (34.6%) ratios complemented by mandibular tooth deficiency in both arches (14.3% and 28.8% respectively). As opposed to findings in Malay subjects, Chinese subjects presented with more problems in the mandibular arch, due to mandibular excess (20.4%, 29.7%) and maxillary deficiency (24.1%, 29.7%) in both anterior and overall ratios respectively (Table 4 ). Indian subjects on the other hand presented with equally fair distributions of all problem area with main problem of anterior ratio located 25% in the maxilla due to excess and locating overall ratio problem due to maxillary deficiency in 22.7% of subjects. McLaughlin et al. [ 26 ] found that there are more common to find an excess of tooth substance in the lower arch as found in the Chinese sample in this study. The authors mentioned that it is usual to reduce tooth mass in the lower incisors by inter-proximal enamel reduction and/or by addition of tooth mass with restorative materials in the opposing arch of upper incisors, commonly the laterals. In the present study, high incidence of mandibular excess and maxillary deficiency in our Chinese samples could be contributed by high prevalence of Class III malocclusion found among Chinese. This is supported by Woon et al. [ 27 ] that there was a high percentage of edge to edge incisor relationship in Chinese (54%), followed by Malay (50%) whilst the Indian had 38%. In this study we are comparing the malocclusion using BSI classifications which only relate the relationships between the upper incisors and lower incisors’ edges and found no correlation of TSD with malocclusion class ( Table 2 ) . This finding is in agreement with Laino et al. [ 28 ]. However, our study is in dispute with a study by Mulimani et al, [ 29 ] which found a significant correlation between malocclusion classes. Malay samples displayed more maxillary tooth excess as presented in Table 4 . It was reported [ 27 ] that Malay presented with the highest percentage of increased overjet problem (16.11%) as compared to Chinese (12.75%) and Indians (9.52%). In clinical practice, clinicians often note the discrepancy of tooth size and skeletal size but seldom pay attention to TSD between maxillary and mandibular teeth. From this study, it might be reasonable for orthodontists to denote interproximal stripping or tooth extraction in the mandibular dentition for mandibular tooth size excess which is common in Class III malocclusion and in the maxillary dentition for maxillary tooth size excess, a common presentation of Class II malocclusion. These results suggested that the Bolton analysis is important and should be considered when diagnosing, planning, and predicting prognosis in clinical orthodontics. With relatively high tooth excess with the opposing arch, it is another factor to consider for extractions decision. Bolton himself had stated the effects of extractions that can reduce the existing high anterior or overall ratios and this are supported by Saatci and Yukay [ 30 ]. Conclusion Significant differences in the ratios between Malays and Chinese in the anterior ratio and between Malays and Chinese and between Malays and Indians in the overall ratio suggest that population specific standards are necessary for clinical assessments. The Bolton standards can be applied to Malaysian Chinese and Indians but not to Malays orthodontic population for both anterior and overall ratios. Subsequently, a specific standard should be used for the Malays orthodontic population. There were 20.7% of Malaysian sample fall beyond suggested 2 SD of clinically significance for anterior ratio and 4.7% which fall in this definition for overall ratio. It was found that more Malay subjects presented with maxillary excess contrary to Chinese and Indian which presented more maxillary deficiency for the anterior and overall ratio. Abbreviations TSD Tooth size discrepancy ANOVA Analyses of variance HATS Hamilton Arch Tooth System SPSS Statistical Package for Social Sciences SD Standard Deviations Declarations Ethics approval and consent to participate All methods were carried out in accordance with relevant guidelines and regulations. All experimental protocols were approved by the Ethics Committee of the Universiti Teknologi MARA (FRC/03/2022) as routine diagnostic procedures and confirm that informed consent was obtained from all participants or, if participants are under 16, from a parent and/or legal guardian(s). Consent for publication - Not applicable Availability of data and material All data generated or analysed during this study are included in this published article [and its supplementary information files]. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interest The authors declare that they have no competing interests. Funding This study was supported by grants from Institut Pengurusan dan Pemantauan Penyelidikan, Universiti Malaya grant number: (PPP)/P0076/2008C and (PPP)/P0094/2009C. Authors' contributions ANA and SA measured the study casts and interpreted the patient data. SA was involved in the data collection, AM helped in the data analyses. ANA was a major contributor to writing the manuscript. All authors read and approved the final manuscript. Acknowledgements Dr Marhazlinda Jamaludin and Ms Salmi Md Zahid for their statistical assistance. Authors' information (optional) -Not applicable. References Bolton WA. Disharmony in tooth size and its relation to the analysis and treatment of malocclusion. Angle Orthod 1958;28(3):113–30. Abd.Rahman ANA, Othman SA. Comparison of Tooth Size Discrepancy of Three Main Ethnics in Malaysia with Bolton’s Ratio. Sains Malaysiana 2012;41(2):271–5. Ta TA, Ling JYK, Hägg U. Tooth-size discrepancies among different occlusion groups of southern Chinese children. Am J Orthod Dentofacial Orthop 2001;120(5):556–8. Endo T, Abe R, Kuroki H, Oka K, Shimooka S. Tooth size discrepancies among different malocclusions in a Japanese orthodontic population. Angle Orthod. 2008;78(6):994–9. Higashihori N, Takada J, Katayanagi M. et al. Frequency of missing teeth and reduction of mesiodistal tooth width in Japanese patients with tooth agenesis. Prog Orthod. 2018;19,30. Lew KK, Keng SB. Anterior crown dimensions and relationship in an ethnic Chinese with normal occlusions. Aust Orthod J. 1991;12(2):105–9. Bishara SE, Jakobsen JR, Abdallah EM, Garcia AF. Comparison of mesiodistal and buccolingual crown dimensions of the permanent teeth in three populations from Egypt, Mexico, and The United States. Am J Orthod Dentofacial Orthop. 1989;95(1):46–58. Bernabe˘ E, Major PW, Flores-Mir C. Tooth-width ratio discrepancies in a sample of Peruvian adolescents. Am J Orthod Dentofacial Orthop. 2004;125:361–365. Al-Khateeb SN, Abu Alhaija ESJ. Tooth Size Disrepancies and Arch Parameters among Different Malooclusions in a Jordanian Sample. Angle Orthod. 2006;76:459–465. Altherr ER, Koroluk LD, Phillips C. Influence of sex and ethnic tooth-size differences on mixed dentition space analysis. Am J Orthod Dentofacial Orthop. 2007;132:332–339. Endo T, Isao S, Ryota A, Katsuyuki I, Sugako Y, Shohachi S. Applicability of Bolton’s tooth size ratios to a Japanese orthodontic population. Odontology. 2007b;95:57–60. O’ Mahony G, Millet DT, Barry MK, McIntyre GT, Cronin MS. Tooth size discrepancies in Irish orthodontic patients among different malocclusion groups. Angle Orthod. 2011;81:132–135. Othman SA, Harradine NWT. Tooth size discrepancies in an Orthodontic Population. Angle Orthod. 2007a;77:668–74. Bolton WA. The clinical application of a tooth size analysis. Am J Orthod. 1962;48:504–529. Paredes V, Gandia JL, Cibrian R. Do Bolton’s ratios apply to a Spanish population?. Am J Orthod Dentofacial Orthop. 2006b;129:428–30. Mirzakouchaki B, Shahrbaf S, Talebiyan R. Determining tooth size ratio in an Iranian-Azari population. J Contemp Dent Pract. 2007;8:86–93. Smith SS, Buschang PH, Watanabe E. Interarch tooth size relationships of 3 populations: “Does Bolton’s analysis apply?”. Am J Orthod Dentofacial Orthop 2000;117:169–74. Proffit WR, Fields Jr HW. Contemporary Orthodontics. 3rd edition. St Louis, MO: Mosby 2000.p.170. Othman SA, Harradine NWT. Tooth size discrepancy and Bolton’s ratios: a literature review. J Orthod. 2006;33:45–51. Crosby DR, Alexander CG. The occurrence of tooth size discrepancies among different malocclusion groups. Am J Orthod Dentofacial Orthop. 1989;95:457–461. Freeman JE, Maskeroni AJ, Lorton L. Frequency of Bolton tooth size discrepancies among orthodontic patients. Am J Orthod Dentofacial Orthop. 1996;110:24–27. Santoro M, Ayoub ME, Pardi VA, Cangialosi TJ. Mesiodistal crown dimensions and tooth size discrepancy of the permanent dentition of Dominican Americans. Angle Orthod. 2000;70:303–307. Araujo E, Souki M. Bolton anterior tooth size discrepancies among different malocclusion groups. Angle Orthod. 2003;73:307–313. Endo T, Uchikura K, Ishida K, Shundo I, Sakaeda K, Shimooka S. Thresholds for clinically significant tooth-size discrepancy. Angle Orthod. 2009;79:740–746. Proffit WR., Fields Jr, HW, Sarver DM. Contemporary Orthodontics. 4th edition. St Louis, MO: Mosby 2007;199–201. McLaughlin RP, Bennett JC, Trevisi HJ. (2001). Systemized Orthodontic Treatment Mechanics. London, Mosby; 2001.p.282. Woon KC, Thong YL, Abdul Kadir R. Permanent dentition occlusion in Chinese, Indian and Malay groups in Malaysia. Aust. Orthod. J. 1989;11(1): 45–48. Laino A, Quaremba G, Paduano S. and Stanzione S. Prevalence of tooth-size discrepancy among different malocclusion groups. Progress in Orthodontics 2003; 4: 37–44. Mulimani PS, Azmi MI, Jamali NN, Soe HH. Bolton’s tooth size discrepancy in Malaysian orthodontic patients: Are occlusal characteristics such as overjet, overbite, midline, and crowding related to tooth size discrepancy in specific malocclusions and ethnicities?. APOS Trends Orthod 2018;8:36–43. Saatçi P, Yukay F. The effect of premolar extractions on tooth-size discrepancy. Am J Orthod Dentofacial Orthop. 1997;111:428–34. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Aug, 2023 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Major revision 10 Oct, 2022 Reviews received at journal 09 Oct, 2022 Reviewers agreed at journal 02 Oct, 2022 Reviews received at journal 02 Oct, 2022 Reviewers agreed at journal 30 Sep, 2022 Reviewers invited by journal 01 Sep, 2022 Editor assigned by journal 01 Sep, 2022 Editor invited by journal 19 Aug, 2022 Submission checks completed at journal 19 Aug, 2022 First submitted to journal 30 Jul, 2022 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. 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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-1911101","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":130159322,"identity":"97f9d5df-7cb0-4441-9495-da4a9b46325b","order_by":0,"name":"Aida Nur Ashikin Abd Rahman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIie3Qv0vEMBTA8VcC1SHYTQrF9l94pXAo/WdaBLuceiCIg0Omugi31v+i4uJoeKhLpGsGh5tuPjeH4zC2DoKtp5tIvhAIDz7kB4DN9hdjgB87DlIghGbSzX9MEmBsDYFPxBEAuYA1xLtg1wvnlo696ZOU1eS5qB+9+xrO0lxsK+wjPrknvqNor9JHmaxxflgTczWoIhfBuJcAcfSdkhA0RzlD6oiZDJKIePL6TqJGtaTAlqyGCRIftafg3RjNxSjriBgmMbmnu05ZYKwNqZDiK2IjnT0USRkcTPpI2NCNuXmKYaOSl8slRVuNnOvFebozDfbr3ueb2PLLKDPLhc3+H/uujdmvic1ms/3H3gCYTWaTfjhy4gAAAABJRU5ErkJggg==","orcid":"","institution":"Universiti Teknologi MARA","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Aida","middleName":"Nur Ashikin Abd","lastName":"Rahman","suffix":""},{"id":130159323,"identity":"97c6929f-03ac-4622-9c24-d17f568e93b2","order_by":1,"name":"Siti Adibah Othman","email":"","orcid":"","institution":"University of Malaya","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Siti","middleName":"Adibah","lastName":"Othman","suffix":""},{"id":130159324,"identity":"9fe836e2-9e67-40e1-8bfe-aa553ad8b9ab","order_by":2,"name":"Anand Marya","email":"","orcid":"","institution":"University of Puthisastra","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anand","middleName":"","lastName":"Marya","suffix":""}],"badges":[],"createdAt":"2022-07-30 05:14:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1911101/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1911101/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-023-03185-7","type":"published","date":"2023-08-02T21:51:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":26660580,"identity":"6f38b3b0-69fa-467f-b5cc-207535a46b99","added_by":"auto","created_at":"2022-09-19 16:48:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":522767,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003eMeasuring the a) Anterior and b) Overall Ratio\u003c/u\u003e\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-1911101/v1/7574fc1871306faefe321efb.png"},{"id":26660640,"identity":"11804cf5-fef9-4721-82f1-3db42a465d78","added_by":"auto","created_at":"2022-09-19 16:53:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35726,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003eshows the scatterplot to visualize the distribution of the correlation data which is shown to have a linear relationship between the two variables.\u003c/u\u003e\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-1911101/v1/8f9fe2db22b38c3c55c11e3a.png"},{"id":26660578,"identity":"543fec62-9b1d-47af-8429-fc2ca7ab417f","added_by":"auto","created_at":"2022-09-19 16:48:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":50698,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003ePercentage of subjects categorized according to standard deviation from anterior ratio in Malaysian sample and ethnic groups\u003c/u\u003e\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-1911101/v1/de645cc61af6ae452780250b.png"},{"id":26660577,"identity":"8a8821ce-a5fc-4f15-94b9-5dd25323cc14","added_by":"auto","created_at":"2022-09-19 16:48:27","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":48805,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003ePercentage of subjects categorized according to standard deviation from overall ratio in Malaysian sample and ethnic groups\u003c/u\u003e\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-1911101/v1/82112f4b81e43f54a0e2b468.png"},{"id":44735620,"identity":"04161097-7542-4bc8-a0fe-01876cb67560","added_by":"auto","created_at":"2023-10-16 22:26:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1158514,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1911101/v1/48a4a84a-7075-4227-9497-383b98d92a6d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFrequencies of Clinically Significance Tooth Size Discrepancies Among Different Ethnicity in Malaysia\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThe Bolton analysis is one of the commonly used tooth size analysis or diagnostic tools in deriving a treatment plan for orthodontic patient. However, Bolton [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e] had carried out the study in 55 excellent occlusion cases among Caucasians. From his study, he formulated that overall ratio of 91.3 (\u0026plusmn;\u0026thinsp;1.91%) and anterior ratio of 77.2 (\u0026plusmn;\u0026thinsp;1.65%) will achieve a good interdigitation with good occlusion.\u003c/p\u003e\n\u003cp\u003eAbd-Rahman and Othman [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e] stated that numerous studies have indicated that normal measurements for one ethnic group should not be considered normal for other ethnic groups. A possible indication for population-specific standards are necessary for clinical assessments of each population, namely the Malaysian population.\u003c/p\u003e\n\u003cp\u003eStudies carried out to Asian population which also demonstrated differences among malocclusion groups among southern Chinese children in Hong Kong [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e] and Japanese orthodontic population [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e] have suggested a different standard than Bolton\u0026rsquo;s although a study done among Class I Singaporean Chinese found a comparable result with Bolton\u0026rsquo;s standard [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003ePrevious studies have shown that tooth size ratios are ethnicity, and sex-specific and that populations differ with respect to interarch tooth-size relationships, and differences in tooth sizes [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]. Tooth size exhibits a continuous range of variation among individuals and between populations. The variation in tooth size is influenced by genetic, environmental factors, ethnicity and gender. Several studies have demonstrated that mesiodistal crown diameters of males are larger than females [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e] but however, this does not mean that they have larger tooth size ratios or an increased prevalence of tooth size discrepancies (TSD) [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe high prevalence of TSD in orthodontic population in relative to the general population has been well documented [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. Findings of the norms will be a guide in determining the TSD in orthodontic populations that require orthodontic treatment. These values will be in turn converted in millimeters for decision in the treatment planning whether interproximal approximation is required for arch coordination and ideal interdigitation or reduction in tooth structures or even extractions as an option if severe TSD are present.\u003c/p\u003e\n\u003cp\u003eThe second part of Bolton\u0026rsquo;s study [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e] described the clinical application of a tooth size analysis. Clinical application was discussed in depth in term of calculation of the arch length comparisons and determination of TSD in millimeters. The overall ratio was calculated from the summed of the greatest mesiodistal measurements of the teeth in each arch from first molar to first molar. The anterior ratio was calculated from the summed of the greatest mesiodistal measurements of the six anterior teeth in each arch.\u003c/p\u003e\n\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\n\u003ch2\u003eApplications of Bolton Analysis\u003c/h2\u003e\n\u003cp\u003eThe value of correction in millimetres can be taken from the data collection sheet or calculated. Total corrections of anterior and overall ratios were calculated using a given formula and converted in term of millimetres. Bolton ratios were calculated in term of millimetres by employing the Bolton\u0026rsquo;s anterior and overall ratios\u0026rsquo; formula and subtracting the solution from the existing summations of mesiodistal width of upper or lower teeth. The formula then further simplified and applied for accurate calculations in the SPSS as shown below;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cimg 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\" alt=\"\" /\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cspan style=\"text-decoration: underline;\"\u003e\u003cspan class=\"ItalicUnderline\"\u003eUpper correction (mm)\u003c/span\u003e\u003c/span\u003e = (Sum of maxillary \u0026ldquo;6\u0026rdquo; teeth) \u0026ndash; [(Sum of mandibular \u0026ldquo;6\u0026rdquo; teeth)\u0026thinsp;\u0026divide;\u0026thinsp;0.772]\u003c/em\u003e\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u003cspan style=\"text-decoration: underline;\"\u003e\u003cspan class=\"ItalicUnderline\"\u003eLower correction (mm\u003c/span\u003e\u003c/span\u003e\u003cspan style=\"text-decoration: underline;\"\u003e)\u003c/span\u003e = (Sum of mandibular \u0026ldquo;6\u0026rdquo; teeth) \u0026ndash; [(sum of maxillary \u0026ldquo;6\u0026rdquo; teeth)\u003c/em\u003e\u003cstrong\u003e\u0026times;\u003c/strong\u003e\u003cem\u003e0.772]\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cimg 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\" alt=\"\" /\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cspan style=\"text-decoration: underline;\"\u003e\u003cspan class=\"ItalicUnderline\"\u003eUpper correction (mm)\u003c/span\u003e\u003c/span\u003e = (Sum of maxillary \u0026ldquo;12\u0026rdquo; teeth) \u0026ndash; [(Sum of mandibular \u0026ldquo;12\u0026rdquo; teeth)\u0026thinsp;\u0026divide;\u0026thinsp;0.913]\u003c/em\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\n\u003cdiv id=\"Sec16\" class=\"Section4\"\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u003cspan style=\"text-decoration: underline;\"\u003e\u003cspan class=\"ItalicUnderline\"\u003eLower correction (mm)\u003c/span\u003e\u003c/span\u003e= (Sum of mandibular \u0026ldquo;12\u0026rdquo; teeth) \u0026ndash; [(sum of maxillary \u0026ldquo;12\u0026rdquo; teeth)\u003c/em\u003e\u003cstrong\u003e\u0026times;\u003c/strong\u003e\u003cem\u003e0.913]\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eAims of the study\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eTo compare the mean of anterior and overall ratios among the 3 majority ethnic groups in Malaysia; Malay, Chinese and Indian.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eTo compare the mean of anterior and overall ratios with Bolton\u0026rsquo;s original study.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eTo investigate the size and distribution of TSD in the Malaysian orthodontic population and convert the findings in terms of millimeters.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003ch2\u003eSample Selection\u003c/h2\u003e\n\u003cp\u003eDetermined sample size of pretreatment study casts from each ethnic of who have sought orthodontic treatment in Dental Faculty, University of XXXX were selected. The estimation of sample size was calculated by running the G*Power software version 3.197. One hundred and fifty patients with 300 study casts were obtained that fit the inclusion and according to the sample size calculation of minimum 120 samples (40 samples for each ethnic) to satisfy the power of study of 0.8, (\u0026alpha;\u0026thinsp;=\u0026thinsp;0.05; \u0026beta;\u0026thinsp;=\u0026thinsp;0.2) which consisted of 54 Chinese, 52 Malays and 44 Indians.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch2\u003eSelection Criteria\u003c/h2\u003e\n\u003cp\u003eInclusion criteria;\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eMalay, Chinese, and Indian ethnicity. Ethnicity determinations were according to their name and race in the registration form and interview conducted to patients and parents.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eFully erupted and complete permanent dentitions from first molar to contralateral first molar.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eGood quality pretreatment study casts.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eExclusion criteria;\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eClinically visible dental caries, proximal restorations (Class II amalgam or composite), build ups, crowns and onlays that affect the tooth\u0026rsquo;s mesiodistal diameter.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eCongenital defects or deformed teeth.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eObvious interproximal or occlusal wear of teeth.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePrevious or ongoing orthodontic treatment.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePatient who came from mixed race and intermarriage.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n\u003ch2\u003eData Collection\u003c/h2\u003e\n\u003cp\u003eMeasurements of the greatest mesiodistal width of each tooth were taken with the caliper\u0026rsquo;s tips held perpendicular to the long axis of each tooth from the first molar to the first molar of each cast. The mesiodistal widths from the contact points of canine to canine for anterior ratio and first molar to first molar for overall ratio \u003cstrong\u003e(\u003c/strong\u003eFig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e were measured on each cast to the nearest 0.01mm, by using digital calipers (Fowler Pro-Max Calipers) linked to Hamilton Arch Tooth System software (HATS). The HATS software will calculate the anterior and overall ratio of each pair of orthodontic study cast using Bolton analysis. The tooth size corrections will also be calculated by the HATS software. The readings were recorded in the data collection sheet for further statistical management.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n\u003ch2\u003eReliability and Reproducibility of the Measurements\u003c/h2\u003e\n\u003cp\u003eTwo pairs of dental casts selected above were measured by one inter-examiner for data calibration as a gold standard using reliability analysis and intra class correlation by expertise in the field for measurement calibration. A high correlation of 0.994 between the principle investigator and the reference investigator was achieved. For intra-examiner reliability analysis, ten pairs of dental casts were randomly selected systematically by randomization using Statistical Package for the Social Sciences (SPSS) software. Each cast was measured at two separate occasions in two weeks\u0026rsquo; interval by the principle investigator. The paired-sample \u003cem\u003et\u003c/em\u003e-test was used to evaluate the systematic error, and there was no statistically significant systematic error noted with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.5. Our finding shows a very high correlation of Alpha Cronbach\u0026rsquo;s 0.995 between the first and second measurements and indicates that examiner was highly consistent in the measurement of the parameter.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n\u003cp\u003eSkewness test shows data to be within 0\u0026thinsp;\u0026plusmn;\u0026thinsp;2 which is within normal data distribution range. Kolmogorov-Smirnov test of normality was also carried out for every ethnic group and showed no statistic significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), hence data normality was assumed and further parametric test were carried out. Independent \u003cem\u003et-\u003c/em\u003etest was carried out to test for gender differences, two-way ANOVA to identify the effects of malocclusion and ethnic groups and one-sample \u003cem\u003et\u003c/em\u003e-test to compare the means of current study with Bolton\u0026rsquo;s standards.\u003c/p\u003e\n\u003cp\u003eThe data collected from the records were evaluated to determine the percentage of patients who had TSDs which were within one, within two, or greater than two standard deviations from Bolton's mean. A mean, median, range, standard deviation, standard error of the mean, and coefficient of variation were calculated for both the overall \"12\" ratio and anterior \u003cem\u003e\"6\"\u003c/em\u003e ratio. Two-way analyses of variance (ANOVA) were used to correlate the interactions between ethnic and anterior ratio and overall ratio.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\n\u003ch2\u003eApplications of Bolton Analysis\u003c/h2\u003e\n\u003cp\u003eThe value of correction in millimeters was calculated. Total corrections of anterior and overall ratios were calculated using a given formula and converted in term of millimeters. Bolton ratios were calculated in term of millimeters by employing the Bolton\u0026rsquo;s anterior and overall ratios\u0026rsquo; formula and subtracting the solution from the existing summations of mesiodistal width of upper or lower teeth.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFrom Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e it was found that there was no gender difference found (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) within combination samples, and within all ethnicity for female and male and for anterior and overall ratios. Further statistical analyses were carried out without splitting the gender. A consistent trend of relatively higher mean was observed in male subject compared to female subjects in both anterior and overall ratio among all ethnic groups. However, these differences were not of statistically significant.\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\u003eIndependant \u003cem\u003et-\u003c/em\u003etest between gender among Malaysian and different ethnic group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean Difference\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 \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMalaysian (n\u0026thinsp;=\u0026thinsp;150)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMale (n\u0026thinsp;=\u0026thinsp;47)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eFemale (n\u0026thinsp;=\u0026thinsp;103)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAnterior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.85 (2.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77.32 (2.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.243\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.71 (1.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91.28 (1.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMalay (n\u0026thinsp;=\u0026thinsp;52)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMale (n\u0026thinsp;=\u0026thinsp;13)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eFemale (n\u0026thinsp;=\u0026thinsp;39)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAnterior Ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.45 (1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78.29 (2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.821\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOverall Ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.73 (1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91.99 (1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChinese (n\u0026thinsp;=\u0026thinsp;54)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMale (n\u0026thinsp;=\u0026thinsp;15)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eFemale (n\u0026thinsp;=\u0026thinsp;39)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAnterior Ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.84 (1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.42 (2.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOverall Ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.38 (1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.64 (2.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndian (n\u0026thinsp;=\u0026thinsp;44)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMale (n\u0026thinsp;=\u0026thinsp;19)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eFemale (n\u0026thinsp;=\u0026thinsp;25)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAnterior Ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.25 (3.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77.21 (2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOverall Ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.26 (2.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91.18 (1.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.891\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\u003eFrom Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, there were statistical differences found between ethnicity but no interaction found between ethnicity and malocclusion types in the anterior (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.186) or overall ratios (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.073) from two-way ANOVA analyses. Statistical difference was found between ethnicity and post-hoc test was carried out.\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\u003eTwo-way ANOVA of anterior and overall ratios\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e-statistic (df)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAnterior ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.93 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMalocclusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.16 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEthnicity*Malocclusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.57 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eOverall ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.73 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMalocclusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.29 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEthnicity*Malocclusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.19 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.73\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\u003e*\u003c/em\u003e\u003c/sup\u003e\u003cem\u003estatistically significant\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows one sample \u003cem\u003et\u003c/em\u003e-test was used to test the applicability of Bolton\u0026rsquo;s value to Malaysian samples. It was found that there was no significant difference found between the two groups with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.177 of anterior ratio and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.453 for overall ratio with means of 77.49(\u0026plusmn;\u0026thinsp;2.59) and 91.42(\u0026plusmn;\u0026thinsp;1.90) respectively for Malaysian samples. Using Pearson\u0026rsquo;s correlation analysis, it was found that the correlation between anterior and total tooth width ratios was moderate (Pearson\u0026rsquo;s correlation 0.665, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\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\u003eComparison of anterior and overall ratios between Malaysian majority ethnics and Bolton standards\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAnterior Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eOverall Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMalay\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eChinese\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eIndian\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eMalaysian\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eMalay\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eChinese\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eIndian\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eMalaysian\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.33\u003c/p\u003e \u003cp\u003e(2.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.53\u003c/p\u003e \u003cp\u003e(2.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.66\u003c/p\u003e \u003cp\u003e(2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77.49\u003c/p\u003e \u003cp\u003e(2.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e92.18\u003c/p\u003e \u003cp\u003e(1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90.85\u003c/p\u003e \u003cp\u003e(1.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e91.22\u003c/p\u003e \u003cp\u003e(1.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e91.42\u003c/p\u003e \u003cp\u003e(1.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean Range\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76.14\u0026ndash;80.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.06-79.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.82\u0026ndash;80.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.90-\u003c/p\u003e \u003cp\u003e80.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90.62\u0026ndash;93.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e88.86\u0026ndash;92.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e89.31\u0026ndash;93.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e89.52-\u003c/p\u003e \u003cp\u003e93.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBolton (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e77.20 (1.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003e91.30 (1.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003e\u003cem\u003e*\u003c/em\u003e\u003c/sup\u003e\u003cem\u003estatistically significant\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMeans of Malaysian anterior and overall ratios compare favorably to the Bolton standards with no statistically significant difference shown. Hence, Bolton\u0026rsquo;s ratios are applicable to overall Malaysian samples in combination. In the same table, comparing Malay\u0026rsquo;s samples and Bolton\u0026rsquo;s standard, showed highly significant differences between the Malay anterior ratio (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) and overall ratio (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) which suggest non applicability of Bolton\u0026rsquo;s value to Malay ethnic.\u003c/p\u003e \u003cp\u003eHowever, Bolton ratios are found not to have any statistically significant differences when compared with the Chinese and Indians anterior and overall ratios as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.052 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.289 for anterior ratio and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.101 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.777 for overall ratio in Chinese and Indian subjects respectively.\u003c/p\u003e \u003cp\u003eMean range of Malay subjects are found to be on the higher limit and beyond of Bolton\u0026rsquo;s range of both anterior and overall ratios. For anterior ratio, mean range for Malay ethnic group, are between 76.14 to 80.52 compared to Bolton\u0026rsquo;s value between 75.55 to 78.85. For overall ratio of Malay ethnic group, the mean ranging from between 90.62 to 93.74 compared to Bolton\u0026rsquo;s value between 89.39 to 93.21 \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eFor overall ratio \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e, more Malaysian patients in combination requiring addition of maxillary teeth due to maxillary deficiency (16%) and lowest percentage presented at the mandibular region for mandibular excess (12%). More Malay subjects present with maxillary excess (15.4%) and least percentage of subjects present with either mandibular excess in this group (1.9%). Contrary to findings in Malay ethnic group, more subjects presented with maxillary deficiency with 20.4% in Chinese and 11.4% in Indian respectively. However, least percentage of subjects presented with maxillary excess in Chinese (3%) as compared to Indian which have the least mandibular excess problem (4.5%) similarly as found in Malay.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage of subjects with clinically significant tooth-width discrepancies larger than 2.0mm according to ethnic group\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\u003eLow-range proportion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eHigh range proportion\u003c/p\u003e \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\u003e\u003cem\u003eMandibular deficiency\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eMaxillary excess\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eMandibular excess\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMaxillary deficiency\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnterior ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChinese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalaysian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChinese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalaysian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16%\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\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e \u003cb\u003eand\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e illustrate the percentage of upper and lower correction in millimetres for both anterior and overall ratios of each ethnic group. There were mixed combinations of upper and lower corrections required to match the Bolton ratios.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e show the percentages of Malaysian subjects in terms of the upper and lower corrections in millimetres which would be required to give the mean ratio for Bolton\u0026rsquo;s original sample. In these figures, a positive (+) sign on the x axis indicates that the correction to be done is to increase the tooth structure - relative tooth size deficiency, whereas the negative (-) sign indicates that the required correction is to reduce the tooth structure - relative tooth excess.\u003c/p\u003e \u003cp\u003eFor overall ratio as shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, more subjects from Malay ethnic group presented with maxillary excess and mandibular deficiency with the equal percentage of 19.2%. In Chinese, maxillary deficiencies and mandibular excess are the main problems observed with 27.8% and 24.1% of subjects respectively requiring either maxillary tooth addition or mandibular tooth structure reduction. In Indian ethnic group, almost similar finding with Chinese, more subjects presented with maxillary deficiency (13.6%) followed by mandibular deficiency and maxillary excess in 11.4% of samples respectively. Small percentage of subjects presented with mandibular excess consisting of 9.1% which would require mandibular tooth structure reduction or enamel stripping to obtain occlusal fit.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage of subjects according to ethnicity requiring upper and lower anterior correction\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorrection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eUpper anterior\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eLower anterior\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e(mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMalay (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eChinese (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eIndian (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eMalaysian (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eMalay (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eChinese (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eIndian (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eMalaysian (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;-2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e-2 to -1.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e-1.5 to -1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e-1 to -0.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e-0.5 to 0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e0 to 0.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e0.5 to 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1 to 1.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1.5 to 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\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 \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage of subjects according to ethnicity requiring upper and lower overall correction\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorrection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eUpper overall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eLower overall\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e(mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMalay (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eChinese (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eIndian (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eMalaysian (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eMalay (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eChinese (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eIndian (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eMalaysian (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;-2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e-2 to -1.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e-1.5 to -1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e-1 to -0.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e-0.5 to 0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e0 to 0.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e0.5 to 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1 to 1.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1.5 to 2`\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eTSD and Ethnicity\u003c/h2\u003e \u003cp\u003eIn this study, in reflection of Bolton\u0026rsquo;s standard, the results show that Malay subjects have a significantly greater prevalence TSD than the Chinese or the Indians. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e show that there was a very high significant interaction between ethnic group of the anterior ratio and overall ratio (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000). Post hoc test described that there is significant difference observed in anterior ratio between Malay and Chinese subjects (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) and also very high significant differences in overall ratio between Malay and Chinese (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) and between Malay and Indian (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029).\u003c/p\u003e \u003cp\u003eIn comparison of Bolton standards with Malaysian subjects \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e, Malaysian subjects do not show significant difference in both anterior and overall ratios. However, when comparing the ethnic groups in this study with the Bolton findings, it was found that Malay subjects show a highly statistical and clinically differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) in both anterior and overall ratios. Because the type of malocclusion does not predispose a patient to a TSD problem, the differences between our results of Malay mean and Bolton\u0026rsquo;s cannot be explained by the orthodontic samples used. Bolton\u0026rsquo;s anterior and overall ideal ratios were significantly smaller than of the estimates in the current study of Malay subjects, except those for Chinese and Indian subjects. This explained the fact that Bolton\u0026rsquo;s original sample which has been composed primarily of Caucasian samples and implies that the Bolton ratio is only applicable to Malaysian in general but it is not applicable to Malay population in particular.\u003c/p\u003e \u003cp\u003eA few other similar studies are in agreement with the findings of the present study, indicating specific tooth size standard for their populations; Spanish [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], Japanese [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and Iranian-Azari [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] of both the anterior and overall ratios. Ta et al., [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] found that Bolton\u0026rsquo;s standard is only applicable to their Class I occlusion of Southern Chinese but not to those of Class II and Class III occlusion. Whilst Smith et al., [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] who studied was on Bolton\u0026rsquo;s applicability on three populations; Black, Hispanics and White, found that Bolton ratios apply to white females only; the ratios should not be indiscriminately applied to white males, blacks, or Hispanics. They also concluded that interarch tooth size relationships are population and gender specific. In this study we found no significant difference for gender (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eFrequencies of Bolton TSD\u003c/h2\u003e \u003cp\u003eProffit [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] quoted that prevalence of TSD in the general population as being 5%. Othman and Harradine [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] noted that the basis for this prevalence was not explained and maybe defined as the proportion of cases that will fall outside 2SD from Bolton\u0026rsquo;s mean ratios. Based on this definition, sample of this study consist of 20.7% of anterior ratio TSD and 4.7% prevalence of overall ratio TSD. It was found to vary among different findings of different populations.\u003c/p\u003e \u003cp\u003eThere was higher incident of Malaysian subjects that fall beyond 2SD of Bolton anterior ratios as compared to overall ratio. Our findings are in agreement as that found by Crosby and Alexander [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] when comparing (3\u0026ndash;3) anterior and (6\u0026ndash;6) overall ratios, the authors found that in every malocclusion group, there is a greater percentage of patients with anterior mesial-distal TSD greater than 2SD from Bolton\u0026rsquo;s mean as compared with patients with overall discrepancies. The higher prevalence of anterior TSD seems to be quite agreeable to most authors [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis is true whether we are looking at maxillary or mandibular tooth size excesses and results from the present study are in agreement with findings from Crosby and Alexander [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This could be explained by the fact that anterior teeth, especially incisors, have a much greater incidence of tooth size deviations. The greatest variables in mesio-distal tooth width occur in the anterior region.\u003c/p\u003e \u003cp\u003eIn the study, it remains questionable which deviations of the overall and anterior values proposed by Bolton affect the final treatment outcome. Peg shaped lateral incisors are easily detected and express most often as TSD. Smith et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] has similarly suggested that maxillary lateral incisors have previously been shown to be quite variable in size and are frequently the reason for a TSD between arches. And in this matter, aesthetic correction (crowns, veneers, etc) is often the first choice of treatment. Hidden TSD from a generalized discrepancy in tooth width between upper and lower teeth is less detectible at first sight and may cause a less favorable treatment outcome. Because the present sample consisted of patients who were in the orthodontic waiting list with high orthodontic treatment need, the presence of a larger percentage of TSD than that in Bolton\u0026rsquo;s sample seem reasonable.\u003c/p\u003e \u003cp\u003eIt is possible that the population of patients may be more diverse in the city of Kuala Lumpur with high migration rate from all over the country concentrated in the capital of Malaysia of which majority of the center\u0026rsquo;s orthodontic patients came from. Thus, the findings of this study may also represent the whole population in the country. It would seem logical that the percentage of patients that present with TSD may be somewhat dependent on the selection process or the characteristics of the population from which the subjects are drawn as observed in this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eDiscrepancy in Millimetres as a Measure of Clinical Significance\u003c/h2\u003e \u003cp\u003eThreshold of 2 standard deviations (SD) of Bolton\u0026rsquo;s mean ratios as clinically significance have been well accepted and documented [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In this present study, 20.7% of Malaysian samples fall beyond the suggested clinically significant 2 SD.\u003c/p\u003e \u003cp\u003eThe three ethnics displayed similar trend out of their sample which fell beyond the 2 SD (19.2% of Malay, 20.4% of Chinese, 22.8% of Indians) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. This figures of clinically significant are in agreement as reported by other studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] but the incidence of overall ratio that fall beyond 2SD in current study are found to be less in combined samples of Malaysian, in Malay and in Chinese sample than reported by this author which are between 5\u0026ndash;14%. In this study, it was found that our sample displayed a lesser percentage of standard deviations of overall ratio in 1.9% in Malay and 3.7% in Chinese but a comparable amount as reported by [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] of 4.7% in Malaysian sample and 9.1% in Indian.\u003c/p\u003e \u003cp\u003eEndo et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] mentioned the importance of TSD expressed in terms of both percentage and amount of millimetres required for correction. The authors quoted \u0026lsquo;ratios outside 2SD and TSD requiring more than 2 mm of maxillary and/or mandibular corrections are recommendable as the appropriate thresholds for clinical significance\u0026rsquo;. Othman and Harradine [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] had raised the issue of the fundamental of an absolute size of discrepancy thought to be incompatible with an acceptable occlusal fit.\u003c/p\u003e \u003cp\u003eProffit suggested that 1.5 mm as a cut-off point to be clinically significant [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This has been accepted by Bernabe et al., [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] in his study as their limit of acceptable discrepancy. A TSD of less than 1.5mm is rarely significant, but larger discrepancies create treatment problems and must be included in the orthodontic problem list at treatment planning stage [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In the current study, subjects requiring more than 2.0 mm corrections of either arches were considered of clinically significant as recommended by recent studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] as a threshold for clinically significant TSD.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows that for anterior ratio in Malaysian combined sample, higher percentage of corrections are required for maxillary deficiency (12%), indicating build ups or permanent prosthesis for increase tooth width and less correction required for mandibular excess (4%) hence tooth structure reduction like interproximal stripping are advocate.\u003c/p\u003e \u003cp\u003eBernabe˘ and coworker [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] stated that the frequency of subjects with clinically significant TSD differs based on which arch is considered \u0026ldquo;normal\u0026rdquo;. If mandibular tooth-width is defined as normal, a tooth discrepancy would be described as a maxillary tooth-width deficiency or excess. From Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e illustrating percentage of subjects with clinically significant tooth-width discrepancies larger than 2.0 mm of Malaysian samples, it was found that in anterior as well as overall ratio, more subjects possessed a maxillary excess than other problems.\u003c/p\u003e \u003cp\u003eHowever, from Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e \u003cb\u003eand\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, illustrating the clinically significant tooth width discrepancies according to ethnic group, it was found that Malay subjects present with more problem located in the maxillary arch due to maxillary excess in both anterior (26.9%) and overall (34.6%) ratios complemented by mandibular tooth deficiency in both arches (14.3% and 28.8% respectively).\u003c/p\u003e \u003cp\u003eAs opposed to findings in Malay subjects, Chinese subjects presented with more problems in the mandibular arch, due to mandibular excess (20.4%, 29.7%) and maxillary deficiency (24.1%, 29.7%) in both anterior and overall ratios respectively (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Indian subjects on the other hand presented with equally fair distributions of all problem area with main problem of anterior ratio located 25% in the maxilla due to excess and locating overall ratio problem due to maxillary deficiency in 22.7% of subjects. McLaughlin et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] found that there are more common to find an excess of tooth substance in the lower arch as found in the Chinese sample in this study. The authors mentioned that it is usual to reduce tooth mass in the lower incisors by inter-proximal enamel reduction and/or by addition of tooth mass with restorative materials in the opposing arch of upper incisors, commonly the laterals.\u003c/p\u003e \u003cp\u003eIn the present study, high incidence of mandibular excess and maxillary deficiency in our Chinese samples could be contributed by high prevalence of Class III malocclusion found among Chinese. This is supported by Woon et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] that there was a high percentage of edge to edge incisor relationship in Chinese (54%), followed by Malay (50%) whilst the Indian had 38%.\u003c/p\u003e \u003cp\u003eIn this study we are comparing the malocclusion using BSI classifications which only relate the relationships between the upper incisors and lower incisors\u0026rsquo; edges and found no correlation of TSD with malocclusion class \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. This finding is in agreement with Laino et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, our study is in dispute with a study by Mulimani et al, [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] which found a significant correlation between malocclusion classes.\u003c/p\u003e \u003cp\u003eMalay samples displayed more maxillary tooth excess as presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. It was reported [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] that Malay presented with the highest percentage of increased overjet problem (16.11%) as compared to Chinese (12.75%) and Indians (9.52%).\u003c/p\u003e \u003cp\u003eIn clinical practice, clinicians often note the discrepancy of tooth size and skeletal size but seldom pay attention to TSD between maxillary and mandibular teeth. From this study, it might be reasonable for orthodontists to denote interproximal stripping or tooth extraction in the mandibular dentition for mandibular tooth size excess which is common in Class III malocclusion and in the maxillary dentition for maxillary tooth size excess, a common presentation of Class II malocclusion.\u003c/p\u003e \u003cp\u003eThese results suggested that the Bolton analysis is important and should be considered when diagnosing, planning, and predicting prognosis in clinical orthodontics. With relatively high tooth excess with the opposing arch, it is another factor to consider for extractions decision. Bolton himself had stated the effects of extractions that can reduce the existing high anterior or overall ratios and this are supported by Saatci and Yukay [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eSignificant differences in the ratios between Malays and Chinese in the anterior ratio and between Malays and Chinese and between Malays and Indians in the overall ratio suggest that population specific standards are necessary for clinical assessments. The Bolton standards can be applied to Malaysian Chinese and Indians but not to Malays orthodontic population for both anterior and overall ratios. Subsequently, a specific standard should be used for the Malays orthodontic population. There were 20.7% of Malaysian sample fall beyond suggested 2 SD of clinically significance for anterior ratio and 4.7% which fall in this definition for overall ratio. It was found that more Malay subjects presented with maxillary excess contrary to Chinese and Indian which presented more maxillary deficiency for the anterior and overall ratio.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e "},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTooth size discrepancy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalyses of variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHATS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHamilton Arch Tooth System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll methods were carried out in accordance with relevant guidelines and regulations. All experimental protocols\u0026nbsp;were approved by the Ethics Committee of the Universiti Teknologi MARA (FRC/03/2022)\u0026nbsp;as routine diagnostic procedures and\u0026nbsp;confirm that informed consent was obtained from all participants or, if participants are under 16, from a parent and/or legal guardian(s).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication -\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files]. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by grants from Institut Pengurusan dan Pemantauan Penyelidikan, Universiti Malaya\u0026nbsp;grant number: (PPP)/P0076/2008C and (PPP)/P0094/2009C.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eANA and SA measured the study casts and interpreted the patient data. SA was involved in the data collection, AM helped in the data analyses. ANA was a major contributor to writing the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr Marhazlinda Jamaludin and Ms Salmi Md Zahid for their statistical assistance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional)\u003c/strong\u003e -Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e \u003cli\u003e\u003cspan\u003eBolton WA. Disharmony in tooth size and its relation to the analysis and treatment of malocclusion. Angle Orthod 1958;28(3):113\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbd.Rahman ANA, Othman SA. Comparison of Tooth Size Discrepancy of Three Main Ethnics in Malaysia with Bolton\u0026rsquo;s Ratio. Sains Malaysiana 2012;41(2):271\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTa TA, Ling JYK, H\u0026auml;gg U. Tooth-size discrepancies among different occlusion groups of southern Chinese children. Am J Orthod Dentofacial Orthop 2001;120(5):556\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEndo T, Abe R, Kuroki H, Oka K, Shimooka S. Tooth size discrepancies among different malocclusions in a Japanese orthodontic population. Angle Orthod. 2008;78(6):994\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHigashihori N, Takada J, Katayanagi M. et al. Frequency of missing teeth and reduction of mesiodistal tooth width in Japanese patients with tooth agenesis. Prog Orthod. 2018;19,30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLew KK, Keng SB. Anterior crown dimensions and relationship in an ethnic Chinese with normal occlusions. Aust Orthod J. 1991;12(2):105\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBishara SE, Jakobsen JR, Abdallah EM, Garcia AF. Comparison of mesiodistal and buccolingual crown dimensions of the permanent teeth in three populations from Egypt, Mexico, and The United States. Am J Orthod Dentofacial Orthop. 1989;95(1):46\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernabe˘ E, Major PW, Flores-Mir C. Tooth-width ratio discrepancies in a sample of Peruvian adolescents. Am J Orthod Dentofacial Orthop. 2004;125:361\u0026ndash;365.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Khateeb SN, Abu Alhaija ESJ. Tooth Size Disrepancies and Arch Parameters among Different Malooclusions in a Jordanian Sample. Angle Orthod. 2006;76:459\u0026ndash;465.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAltherr ER, Koroluk LD, Phillips C. Influence of sex and ethnic tooth-size differences on mixed dentition space analysis. Am J Orthod Dentofacial Orthop. 2007;132:332\u0026ndash;339.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEndo T, Isao S, Ryota A, Katsuyuki I, Sugako Y, Shohachi S. Applicability of Bolton\u0026rsquo;s tooth size ratios to a Japanese orthodontic population. Odontology. 2007b;95:57\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo; Mahony G, Millet DT, Barry MK, McIntyre GT, Cronin MS. Tooth size discrepancies in Irish orthodontic patients among different malocclusion groups. Angle Orthod. 2011;81:132\u0026ndash;135.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOthman SA, Harradine NWT. Tooth size discrepancies in an Orthodontic Population. Angle Orthod. 2007a;77:668\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBolton WA. The clinical application of a tooth size analysis. Am J Orthod. 1962;48:504\u0026ndash;529.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParedes V, Gandia JL, Cibrian R. Do Bolton\u0026rsquo;s ratios apply to a Spanish population?. Am J Orthod Dentofacial Orthop. 2006b;129:428\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMirzakouchaki B, Shahrbaf S, Talebiyan R. Determining tooth size ratio in an Iranian-Azari population. J Contemp Dent Pract. 2007;8:86\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith SS, Buschang PH, Watanabe E. Interarch tooth size relationships of 3 populations: \u0026ldquo;Does Bolton\u0026rsquo;s analysis apply?\u0026rdquo;. Am J Orthod Dentofacial Orthop 2000;117:169\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eProffit WR, Fields Jr HW. Contemporary Orthodontics. 3rd edition. St Louis, MO: Mosby 2000.p.170.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOthman SA, Harradine NWT. Tooth size discrepancy and Bolton\u0026rsquo;s ratios: a literature review. J Orthod. 2006;33:45\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrosby DR, Alexander CG. The occurrence of tooth size discrepancies among different malocclusion groups. Am J Orthod Dentofacial Orthop. 1989;95:457\u0026ndash;461.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreeman JE, Maskeroni AJ, Lorton L. Frequency of Bolton tooth size discrepancies among orthodontic patients. Am J Orthod Dentofacial Orthop. 1996;110:24\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantoro M, Ayoub ME, Pardi VA, Cangialosi TJ. Mesiodistal crown dimensions and tooth size discrepancy of the permanent dentition of Dominican Americans. Angle Orthod. 2000;70:303\u0026ndash;307.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAraujo E, Souki M. Bolton anterior tooth size discrepancies among different malocclusion groups. Angle Orthod. 2003;73:307\u0026ndash;313.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEndo T, Uchikura K, Ishida K, Shundo I, Sakaeda K, Shimooka S. Thresholds for clinically significant tooth-size discrepancy. Angle Orthod. 2009;79:740\u0026ndash;746.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eProffit WR., Fields Jr, HW, Sarver DM. Contemporary Orthodontics. 4th edition. St Louis, MO: Mosby 2007;199\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLaughlin RP, Bennett JC, Trevisi HJ. (2001). Systemized Orthodontic Treatment Mechanics. London, Mosby; 2001.p.282.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoon KC, Thong YL, Abdul Kadir R. Permanent dentition occlusion in Chinese, Indian and Malay groups in Malaysia. Aust. Orthod. J. 1989;11(1): 45\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaino A, Quaremba G, Paduano S. and Stanzione S. Prevalence of tooth-size discrepancy among different malocclusion groups. Progress in Orthodontics 2003; 4: 37\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMulimani PS, Azmi MI, Jamali NN, Soe HH. Bolton\u0026rsquo;s tooth size discrepancy in Malaysian orthodontic patients: Are occlusal characteristics such as overjet, overbite, midline, and crowding related to tooth size discrepancy in specific malocclusions and ethnicities?. APOS Trends Orthod 2018;8:36\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaat\u0026ccedil;i P, Yukay F. The effect of premolar extractions on tooth-size discrepancy. Am J Orthod Dentofacial Orthop. 1997;111:428\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tooth size discrepancy, Bolton analysis, Malaysian, anterior ratio, overall ratio.","lastPublishedDoi":"10.21203/rs.3.rs-1911101/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1911101/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The Bolton analysis is one of the commonly used tooth size analysis or diagnostic tools in deriving a treatment plan for orthodontic patient. Many studies have indicated and concluded that normal measurements for one group should not be considered normal for other ethnic groups. The aims and objectives of this study were to investigate the applicability of Bolton’s ratios in orthodontic population of Malaysian main ethnics; Malay, Chinese and Indians. Comparisons were made in term of size and distribution of tooth size discrepancy in Malaysian orthodontic population and the findings were converted in terms of millimetres.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Hundred fifty pre-orthodontic study casts comprised of 52 Malay, 54 Chinese and 44 Indian patients were selected. Digital callipers (Fowler Pro-Max) link to Hamilton Tooth Arch Software were used to measure the tooth width and ratios. Statistical analysis was carried out to test for gender differences (independent\u003cem\u003e t-\u003c/em\u003etest), to identify the effects of malocclusion and ethnic groups (Two-way ANOVA) and to compare the means of current study with Bolton’s standards (one sample \u003cem\u003et\u003c/em\u003e-test).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: This study showed that there was no significant difference between genders of sample of each ethnic. There was no correlation found between ethnic groups and malocclusion classes. There was a significant difference when comparing Bolton values with Malay sample for both ratios. It was found that more Malay subjects presented with maxillary excess contrary to Chinese and Indian which presented more maxillary deficiency for the anterior and overall ratio.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: there were 20.7% of Malaysian sample fall beyond suggested 2SD of clinically significant for anterior ratio and 4.7% which fall in this definition for overall ratio. The Bolton standards can be applied to Malaysian Chinese and Indians but not to Malays ethnic group. Subsequently, a specific standard should be used for the Malays orthodontic population.\u003c/p\u003e","manuscriptTitle":"Frequencies of Clinically Significance Tooth Size Discrepancies Among Different Ethnicity in Malaysia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-19 16:48:25","doi":"10.21203/rs.3.rs-1911101/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-10-10T18:32:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-10-09T05:11:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12048f2d-ae0b-497a-9fa0-092328543fda","date":"2022-10-03T03:58:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-10-03T02:09:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1b97cd81-102c-4d7b-8c28-62aea5896dc0","date":"2022-10-01T02:27:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-09-01T11:43:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-09-01T11:40:38+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-08-19T13:10:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-08-19T13:07:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2022-07-30T04:59:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4b4651e7-d9d1-45ce-9dab-8d7d42b989bb","owner":[],"postedDate":"September 19th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T22:12:03+00:00","versionOfRecord":{"articleIdentity":"rs-1911101","link":"https://doi.org/10.1186/s12903-023-03185-7","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2023-08-02 21:51:42","publishedOnDateReadable":"August 2nd, 2023"},"versionCreatedAt":"2022-09-19 16:48:25","video":"","vorDoi":"10.1186/s12903-023-03185-7","vorDoiUrl":"https://doi.org/10.1186/s12903-023-03185-7","workflowStages":[]},"version":"v1","identity":"rs-1911101","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1911101","identity":"rs-1911101","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}