Background: Bolton’s two main ratios describing the proportional size of upper and lower teeth, could contribute to estimating the excess or deficiency of tooth size necessary to obtain an ideal occlusion. However, the mean Bolton values are not the same among different societies. Determining the prevalence of tooth size deviations from population-specific Bolton indices might help local orthodontists to have a more concise treatment plan.
Objective: The study aimed to define the prevalence of clinically significant tooth size discrepancies (TSD) in an Iranian population and to evaluate the influence of lateral incisors’ size on this discrepancy. 
Methods: This cross-sectional study was conducted on study casts of orthodontic patients attending Imam Reza Dental Clinic from September 2008 to December 2016. The sample comprised of 150 randomly selected pre-treatment study casts (64 males and 86 females from 17 to 28). The mesiodistal diameter of all permanent teeth from the first molar on the right to the first molar on the left was measured using 2 similar digital calipers, and Bolton analysis was calculated. Subjective visual estimation of Bolton discrepancy was also performed. SPSS v18.0, Wilcoxon signed ranks test, Pearson correlation and Receiver Operating Characteristic (ROC) curve analysis were used for statistical analysis. A p<0.05 was considered statistically significant.
Results: In the sample group, 34.7% had anterior Bolton index (ABI) and 20.7% had total Bolton index (TBI) greater than 2 Standard Deviations (2SDs) of Bolton’s means, and about half of them required correction of the ABI considering the actual size of discrepancies (mm). The sensitivity of estimating clinically significant tooth size discrepancy more than 2SDs of Bolton’s ABI and the visual judgment was 96.0% and a cut-off point of -0.12mm was obtained.
Conclusion: Bolton's analysis should be routinely performed in all orthodontic patients, and visual estimation of TSD would be suggested as a screening method in the first visit prior to measurements and set-ups.


Keywords: Clinical significance, Tooth size discrepancy, Lateral incisor, Iran


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