Space

Analysis

Space analysis in permanent

dentition

Royal London space

analysis
Developed since 1985 but
published AJODO 2000 by
Kirschen et al.

The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Definition
Process that allows an estimation of
the space required in each arch to
fulfil the treatment aims.

Mitchell, Laura. 2006. An introduction to orthodontics. Oxford: Oxford

 Carried out in two phases:

- To determine the space required
- The amount of space that will be
created during treatment

Mitchell, Laura. 2006. An introduction to orthodontics. Oxford: Oxford

Space is required to correct:

Crowding

Arch
contraction

Incisor A-P
change

Level of
occlusal
curves

Upper
incisor
angulation

Upper
incisor
inclination /
torque

Mitchell, Laura. 2006. An introduction to orthodontics. Oxford: Oxford

Crowding

Method recommended: Visual method

measuring the mesiodistal width of any

misaligned teeth in relation to the
available space in the arch.
Crowding/spacing assessed anterior to
6s
Mitchell, Laura. 2006. An introduction to orthodontics. Oxford: Oxford

Crowding

Amount of crowding is classified as:

- Mild (<4mm)
- Moderate (4-8mm)
- Severe (>8mm)

Mitchell, Laura. 2006. An introduction to orthodontics. Oxford: Oxford

Incisor A-P Change

Often necessary to alter the A-P position of

upper incisors, e.g: reducing an overjet.
If incisors are retracted requires space
If incisors are proclined space created

Mitchell, Laura. 2006. An introduction to orthodontics. Oxford: Oxford

Incisor A-P Change

Every millimeter of incisor retraction

requires 2mm of space
Every millimeter of incisor proclination
creates 2mm of space
Wider the intercanine distance and the
shallower the arch depth from the canines
to the mid-incisor point, the greater the A-P
expansion required to accommodate a
given amount of crowding.
The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Level of Occlusal Curves /

Plane

Involves Curve of Spee

The depth of curve is assessed from the
premolar cusps to a flat plane joining the
distal cusp of first permanent molars and
incisors.
Approximate space requirement to flatten a
curve of Spee
Depth of curve (mm)

Space requirement
(mm)

3 or less

1.5

5 or more

Mitchell, Laura. 2006. An introduction to orthodontics. Oxford: Oxford

Level of Occlusal Curves /

Plane

Mitchell, Laura. 2006. An introduction to orthodontics. Oxford: Oxford

Arch Contraction

0.5mm created by each mm of posterior

arch width created (Lee, 2000).
Each millimeter increase in the intermolar
width resulted in a reduction of the A-P
arch depth of 0.28 mm, equivalent to an
decrease in arch perimeter length of 0.56
mm

The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Upper Incisor
Angulation

0.5mm for each tooth

2mm for angulation of all four incisors
Not required for majority of cases

The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Upper Incisor Inclination /

Torque

1mm for each 5 change affecting all 4

teeth. 0.5mm if only 2 teeth proclined.
The objectives of correct incisors torque
is for:
i. Better aesthetics
ii. Stability
iii. Achieving corrects teeth contact without
spacing
iv. Avoid incorrect buccal occlusion

Not required for majority of cases

The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Advantages
Easy
Reliable
Valid

Disdvantages
Overestimate crowding
Little impact on decision
for treatment plan
Driven toward extraction
Doesnt count vertical
and transverse problems

The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Other methods

Visual method
Segmental approach
Brass wire / caliper method
Microscopic reflex technique

The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Space analysis in mixed

Necessary to calculate the size of the
dentition
unerupted teeth
Tanaka &
Johnston 1974
Measurement on
the cast
Moyers Prediction
Values 1973
Combination of cast
and Prediction Table
method

Staley &
Kerber 1980
Combination
of radiographs
and Prediction
Table method

The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Tanaka & Johnston

1974

Measurement of the Teeth from Cast

Requires no radiographs or tables
mesiodistal width
of all 4 lower incisors
+ 10.5mm

mesiodistal with of
mandibular premolars plus
canine (on one side)

mesiodistal width
of all 4 lower
incisors + 11mm

mesiodistal with of maxillary

premolars plus canine (on one
side)

The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Tanaka & Johnston

1974

Measurement of the Teeth from

Radiographs and Cast

Requires an undistorted image and easier with PA

films.
Radiographic enlargement needs to be considered.
Accuracy depends on the quality of the radiograph and
is poor for canine teeth but this technique can be used
on all ethnic groups and for mandibular and maxillary
teeth.

True width of primary molar tooth

____________________________
Radiographic width of premolar

True width of unerupted tooth

____________________________
Radiographic width of unerupted too

The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Moyers Prediction Values

1973

Moyer looked at the width of teeth of North

American Caucasian children and found that
there was a correlation between the width
of the unerupted canines and premolars
and the width of the erupted lower incisors.
The lower incisors were used because of the
great variability of the size of the maxillary
laterals.
Overestimates the size of the unerupted
teeth.
The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Staley & Kerber 1980

Because canines are difficult to estimate from

radiographs Staley & Kerber estimated the size
from the erupted permanent lower incisors and
the radiographic size of the lower premolars.
A graph was produced with a linear correlation
allowing estimation of the size of the lower
canine.
This linear correlation graph was very accurate
but only estimated the size of the mandibular
canine and required radiographs.
The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Conclusion
Accuracy: Staley & Kerber > Tanaka & Johnston >
Moyers
All estimation tables are better because they dont
require radiographs.
Can only be used on Caucasian children (race specific)
Should not be used on patients with obvious tooth
size anomalies.

The Royal London space planning: An integration of space analysis and treatment
planning. Kirschen, Robert H. et al., AJODO. Oct 2000

Space Creation

Extraction

Distalizatio
n of molars

Expansion

Proclination
of incisors

Enamel
interproxim
al stripping
A
combinatio
n of any or
all of the
above

Mitchell, Laura. 2006. An introduction to orthodontics. Oxford: Oxford