Posterior Bolton’s Discrepancy. New Analysis To Solve Old Problems 5 MINUTE SUMMARY

orthodontics In summary

Join me for a summary looking at The Posterior Bolton Discrepancy, a new take on the classic Bolton discrepancy. Wayne Bolton’s analysis has been critically appraised and the outcome from Patrick Foley and his team has been the formation of the posterior Bolton analysis, a new perspective on an established tool in orthodontics which seeks to give better insight into the location of tooth size discrepancies. He has also explored through his research the effects of premolar extractions and the likely outcomes of compromised occlusal outcomes, and where we should expect to see it within the posterior segment.

Wayne Bolton established the Bolton’s ratio:

· Mesial distal widths of teeth

· Original study 55 well treated cases

· Anterior – ideal 77.2%

· Overall 91.3% - Anterior tooth size discrepancy maybe masked by a compensatory posterior discrepancy

What is the posterior Bolton’s ratio

· Not included in original study

· Formular sum of mandibular 4s, 5s, 6s,/ maxillary 4s, 5s, 6s x 100 = 105.27% - data from original Bolton’s study

Ratio confirmed by Mongillo 2021

· N=55 patients ideal outcomes

· Digital casts (from plaster)

· Posterior ratio 105.77% +/- 1.99% Vs Bolton’s data of 105.27%

The effect of 4 premolar extractions on the posterior Bolton ratio

Study: Mongillo 2021 (extraction of all 4s) Holton 2023 (extraction of upper 4s, lower 5s)

· Posterior Bolton increases 107% +/- 2.23% (or U4s and L5s 106.52 +/- 2.52%), ideal digital removal of teeth

· Observed Bolton’s was 110.48 % = 3.18% above Bolton’s ideal

· Space of 1.1mm – 1.28mm remains in mandible when ideal arch – only 1 patient did not have space

Clinical options

i. compromise occlusion

1. slightly class 3 molar and class 1 canine

2. class 1 molar and slightly class 2 canine

ii. IPR upper arch

iii. Bonding

· Anterior and posterior Bolton may be valuable in diagnosis and prediction than an overall Bolton