TAILORED OCCLUSION WITH THE ANTERIOR COEFFICIENT

CECIL W. NEBF, D.D.S., SAN DIEGO, CALIF.

P RODUCING normal occlusion by orthodontic means is now an exact science.

Finished orthodontic cases are produced that are balanced in- all respects,
that is: the position of the teeth correctly related to their base, and the teeth
of the maxilla to those of the mandible. All rotations and spaces are removed.
Vertical height is correctly established if necessary.
This cannot always be done with metallic appliances alone. To Dr. H. D.
Keslingl must go the credit for providing the orthodontist with the means
whereby, if basic treatment is correct, perfect alignment and occlusion free of
band spaces may be obtained through the use of his rubber “tooth positioner. ”
It is the purpose of this article to suggest a method which will further
improve each occlusion by tailoring it to fit its own mathematical measurements.
During basic treatment we spend a great deal of time and care in putting
teeth into occlusion. Especially is this true of the twelve anterior teeth, which
seem in many cases to be the only teeth that concern the parent or the patient.
In some cases proper alignment with the ideal amount of overbite is difficult
to obtain. This could very well be because of a variation in proportionate
tooth size of the upper and lower anterior teeth. This disharmony is known to
exist. Since this problem is of tooth size it seems logical to have some math-
ematical guide to find each normal occlusion’s individual anterior overlap.
In making positioner setups this case individuality is easily noted. It is
not possible to set up every case to a standard degree of overbite and have
perfect alignment and absolute contact of all teeth. This, as suggested, is be-
cause of a difference in size relationship of the upper and lower anterior teeth.
Dr. George Chuck4 of Long Beach, California, noted this variation in his work
on prefabricated arches. He found it was not possible to measure only the upper
teeth and wse a correspondingly smaller lower arch for all cases because of this
occasional size disharmony.
The “anterior coefficient” seems to be one answer to this problem. With
it, it is possible to figure the amount of final overbite of each case and what
effect on the overlap will be obtained by the extraction of, for example, a lower
central incisor.
The anterior coefficient is figured as follows :
With a three-inch pair of dividers with needle-sharp points, the mesiodistal
diameters of the six upper anterior teeth are measured (best measured in the
mouth before starting treatment). The measurements are punched out on a
graph card in a straight line. The total length is measured in millimeters.
The same is done for the lower six anterior teeth. The lower sum is divided
309
310 CFCIL
13 W . VEPB'
_

44.0
into the upper sum and a figul~c such as 1.2” is obtained. -- = 1.2%. This
36.0
is the anterior coef%icient.
In the measuring of over two hundred c*asesa range of 21 points has been
tabulated. The lowest so far measured is 1.17 and the highest is 1.41. (Table
I.) This coefficient can be used as a auide to a normal occlusion’s overlap onl~
if we also have a method of calibrating the overbite.
~‘ABIX 1. ~ARIATIOSS Iii TlIJi: (:OEYI”l(!IES1’
--
I!J’PEK SIX ILJWER SIX INDICATEI)
AXTERIOR ANTERIOR OVERBITE
CASE
L NO . TEETII ‘TEETII (‘Ol<FFJClEST (IN PERCENTAGE) -
711 42.x 34.2 1.25 26
713 44.0 36.0 1.22 20
714 52.2 39.0 1.34 35
716 30.8 40.5 1.26 30
717 47.0 38.0 1.24 25
719 50.6 39.0 1.30 35
721 31.0 40.2 1.27 30
722 46.5 36.8 1.26 30
724 49.x 40.0 1.24 25
725 59.0 36.2 1.35 40
727 43.3 37.0 1.17 10
728 50.6 35.6 1.34
729 43.0 35.2 1.22
730 i51.5 39.5 1.30
736 49.0 38.5 1.27
738 46.0 35.2 1.31 35
739 49.0 38.2 7 28 30
740 44.0 34.8 1.26 30
741 44.5 34.6 1.29 35
743 51.8 12.0 1.23 20
744 ‘is.2 37.2 1.29 35
771 46.0 33.0 1.39 55
776 45.0 37.8 1.18 15
807 53.0 39.0 1.36 40
830 50.5 36.0 1.40 55
847 4.5.0 38.0 1.18 15
848 47.0 34.0 1.38 50
851 48.0 34.0 1.41 55
856 ii.0 35.0 I .34 40
857 I6.0 38.0 1.21 20

Dr. Strang stated in his article, “An Analysis of the Overbite Problem,“”
that “probably the average amount of overbite approximates oqe third the
length of the maxillary incisor crowns.” He measures the overbite as part, of
the length of the upper central incisor crown. This method of overbite measurc-
ment can be reversed to good advantage, that is, to think of overbite in per-
centage of coverage by the upper central incisor over the lower central incisor.
Only in this way can we have an accurate picture of overbite regardless of tooth
length. An end-to-end relationship would be a 0 per cent overbite, and complete
coverage of the lower central incisor would be a 100 per cent overbite. Much-
needed vertical height dictates a small amount of overlap as perfect. A 20 per
cent overlap by this method of calibration seems ideal.
By mathematical computations (Fig. 1) with the Hawley-Bonwell triangle,
it was determined that the coefficient for an end-to-end relationship is 1.10 and
for a 100 per cent overlap is 1.52+. The thicker t,he upper central incisor, the
larger this last figure will be.
 TAILORED OCCLUSION WITH ANTERIOR COEFFICIEKT 311

The “ideal anterior coefficient” has, by the measurement of normal oc-

clusions which show a nicely balanced 20 per cent overbite, been determined
to be 1.20-1.22. Regardless of tooth size or shape, the anterior teeth can always
be made to articulate ideally when the coefficient is close to these figures and
t,he lower incisors are in an upright relationship to the mandibular plane.
When the coefficient is above or below 1.20-1.22, a variation above or below a
20 per cent overbite can be obtained with otherwise perfect occlusion.

DISTAL LOWER CUSPID

LOWER RADIUS (Cl-L) 20 MM.
6) “PPER RADIUS --____ 24 MM.
L -v2.= 1.5 MM.
L-u,
L-u, == 7.5
7.5 MM.
MM.

Fig. L-Computing the mean and extreme overbite.

As a guide to relate the anterior coefficient to the overbite, Table II has

been prepared. These are only approsimat,ions, as they must be because of
variations in tooth thickness.
TABLE II
-
COEFFICIENT PER CENT OVERBITE
1.10 0
1.20 20 (ideal)
1.30
1.40 EZ
1.55t 100
312 CECIL TV. NEFF

It is interesting to note that Tralq,le artificial teeth are manufactured to a

relationship of 100 for the upper six anterior teeth to 83 for t,he lower six an-
tq%r teeth. This gives a coefficient, of I.2047 or 1.20, ideal.
To those who arc interested in the method of computing t,he mean and the
extreme coefficient, the explanation follows :
Refer to Ii’ig. 1. The main inner circle is drawn from a radius of t,he
measurement of the lower anterior teeth, not, the upper, as in the making of an
arch graph.
By measuring the thickness of the necks of many upper central incisors.
the average thickness was found to he 7.5 mm. A case was selected that had an
ideal coefficient of 1.20 and a central incisor of this measurement. Tbc upper
central incisor was 1.5 mm. thick where it, overlapped the lower central incisor.
The sum of the lower anterior teet,h measured 40.0 mm. Using one-half this
measurement as a radius, the inner circle was drawn. Mark off as in the
Hawley-Bonwell triangle the dist,al of the cuspids (L to distal lower cuspid).
The radius for the upper arch is 24 mm. Measure this distance off from point
L on the inner circle and this will give a point that is the distal of the upper
cuspids in protrusive position (D) Approximately halfway between these two
points a line may he drawn that will represent the distal of the upper cuspids
in normal occlusion wilh all the various dtbgrees oi’ overbite.
With the upper radius of 24 mm. and the compass point at 7:Z, mark iI
cross on the distal of t,he cuspid line (&Vi). Again with the radius of ‘24 mm.
and the compass point at both c79 + and Nz. make crosses so that a diagonal lint
may be drawn through the crosses C2 and A.
Using CL? as a center, draw the segment, of a circle from Nl to IT>. This
represents the t,rue arch shape for the upper when the other half is drawn
to Nj. Notice how in comparison to the circle for the lower arch the spaces
between t,he circles arc thicker at, the central incisor and cuspid areas and tbin
down for the lateral incisor area.
7;2 is the labial surface of the upper central incisor in normal occlusion.
TJ1 is the labial surface of the upper central incisor when the whole upper
central incisor is anterior to the lower central incisor as in a 100 per cent over-
bite.
Transfer the distance (l,!~ to Gd) below Cz? on the diagonal lint and get
C3. With the point, of t,he compass at C.3 and the lead at U1, draw a segment.
of a circle to R. The straight line B-711 represents the radius for a 100 per
cent overbite.
Ul-B
.- 30.5
1.52 100 per cent overbite.
Cl-L 20.0
L-D 22.0
1.10 End-to-end coefYicient.
Cl-L zo.0
Application to treutment plnnnin~ : Unfortunately, orthodontic cases of
missing upper lateral incisors are all too common. If such is the case, the upper
first premolar widths must be included as upper anterior teeth. One such case
 TAILORED OCCLUSION WITH ANTERIOR COEFFICIENT 313

on hand measures so that the coefficient including the premolars is 1.27. This
is close to ideal, and finished results without difficulty are expected and ex-
perienced.
A case where a lower central incisor is missing measures to a coefficient of
1.40 using only the five lower anterior teeth. This will represent an overbite
of 50 per cent or more. If one lower premolar is included in the lower anterior
measurement,, and the upper cuspid articulated back of it, the new coefficient
becomes 1.15. This is better as it will be slightly more than an end-to-end
relationship, approximately 5 per cent.
Another case with a lower central incisor completely crowded out is a
temptation to extract this central incisor. The normal coefficient is 1.20 or
ideal. Without this lower central incisor and the upper cuspids articulated
in the normal manner back of the lower cuspids, the coefficient is 1.45. This
indicates close to an 80 per cent overbite. One of three things will follow such
treatment :
1. A large overbite.
2. A pronounced overjet.
3. Buckled upper anterior teeth.
But if one side is treated to a Class III one lower first premolar is then
figured in the lower sum, and a new coefficient of 1.12 is obtained. This is
preferable. ’
A Class III case in which the extraction of a lower central incisor seems
logical because the mandible is so much larger than the maxilla has a coefficient
of 1.32. Minus a lower central incisor and the Class III relationship allowed to
remain on one side, the new coefficient is 1.20 or ideal. Whether or not this
would be the proper procedure in all cases that figure as this one does depends
also on facial analysis.
CONCLUSIONS

It is suspected that everything else being normal an orthodontic or non-

orthodontic normal will settle to the degree of overbite indicated by the anterior
coefficient. To prove this it will be necessary to measure hundreds of normal
occlusions. As normals are not numerous and are hard to contact, this will
take time. So far indications are favorable.
This comparing of upper and lower tooth size has been done before. It
has been suggested that disharmony in tooth size might cause malocclusions.
It seems rather to be the cause of normal occlusions being what they are.

REFERENCES

1. Kesling, H. D.: The Philosophy of the Tooth Positioning Appliance, AM. J. ORTHO-
DONTICS AND ORAL SURG. 31: 297-304, 1945.
2. Kesling, H. D.: Coordinating the Predetermined Pattern and Tooth Positioner With
Conventional Treatment, AM. J. ORTHODONTICS AND ORAL SURG.~~: 284.293,1946.
3. Strang, Robert H. W.: An Analysis of the Overbite Problem, Angle Orthodontist 4: 65
84, 1934.
4. Chuck, George C.: Panel Discussion, Sept. 13, 1948, Edward H. Angle Society, Southern
California Component, Hollywood, Calif.
1011 BANK OF AMERICA BUILDING.