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Influence of tonsillar grade on the dental arch measurements


  • Nofil Ahmad BDS, MDS. Demonstrator Department of Orthodontics, Frontier College of Dentistry, Abbottabad, Pakistan.
  • Mir Hadi Faisal BDS, MDS. Type-D hospital, Khanpur, KPK, Pakistan.
  • Kanwal Zulfiqar BDS, FCPS, M Orth RCSEd (UK). Assistant Professor, Department of Orthodontics, Islamic International Dental Hospital.
  • Muhammad Ahmed BDS, MDS(OMFS). Shaheed Zulfiqar Ali Bhutto medical University.
  • Hajirah Afridi B.D.S. Islamic International Dental Hospital.
  • Ulfat Bashir Raja BDS, MCPS, FCPS, MHPE. Professor of Orthodontics. Islamic International Dental College.


Dental arch, hypertrophy, tonsils


Introduction: Waldeyer’s ring hypertrophy can possibly have a negative impact on the inter arch and intra arch dental anomalies. Previous studies have been carried out to investigate the extent of impact but it still remains controversial. The aim of this study is to seek a correlation between the tonsillar grade of patients and their respective inter arch transverse dimensions.1

Material and Methods:  A cross sectional study of 70 patients, aged between 8 and 12, was conducted at the Department of Orthodontics, Islamic International Dental Hospital, Islamabad. The patients were divided into 5 subgroups according to the Brodsky and Koch Tonsillar grading scale.4 The maxillary and mandibular inter premolar width was measured on their respective casts and subsequently the inter arch transverse dimension was calculated.  The correlation between the tonsillar grade and the inter arch transverse dimension was evaluated using the Spearman Correlation Coefficient using the SPSS 16.0.

Results: The mean age of patients was 10.51 ± 1.36 years. There were 42(60%) male and 28(40%) female cases. There were 1(1.4%) cases who had Grade0, 11(15.7%) cases had Grade 1, 31(44.3%) cases had grade 2, 25(35.7%) cases had Grade 3 and 2(2.9%) cases had Grade 4. The mean maxillary Inter first premolar width was 44.84 ± 8.37 (mm), the mean mandible Inter first premolar width was 45.18 ± 9.89 (mm) and mean interarch transverse dimension was 0.39 ± 1.96 (mm). The correlation between Tonsillar Grades &Inter arch transverse dimension was calculated to be -0.682, p-value < 0.001, which was highly significant.

Conclusions: There is a significant negative correlation between Tonsillar Grades and Inter arch transverse dimension which implies greater the tonsillar grade, lower the transversal dimension of both the arches, leading to a tendency for posterior crossbite. Therefore, prevention programs for orthodontic anomalies must be taken into consideration that arise due to tonsillar hypertrophy early on during development of the dental arches.




How to Cite

Ahmad, N., Faisal, M. H., Zulfiqar, K., Ahmed, M., Afridi, H., & Raja, U. B. (2021). Influence of tonsillar grade on the dental arch measurements. Pakistan Orthodontic Journal, 12(2), 71–76. Retrieved from



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