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THESIS – SYNOPSIS
DR. BRIGIT ALPHONSA GERVASIS
POST GRADUATE STUDENT
DEPARTMENT OF ORTHODONTICS AND
DENTOFACIAL ORTHOPAEDICS
K.V.G. DENTAL COLLEGE & HOSPITAL
KURUNJIBAGH, SULLIA – 574327
DAKSHINA KANNADA
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. NAME OF THE CANDIDATE
: DR.BRIGIT ALPHONSA GERVASIS
POST GRADUATE STUDENT,
AND ADDRESS
DEPT OF ORTHODONTICS AND
DENTOFACIAL ORTHOPAEDICS,
K.V.G DENTAL COLLEGE & HOSPITAL,
KURUNJIBAGH, SULLIA – 574 327
2.
NAME OF THE INSTITUTION
: K.V.G. DENTAL COLLEGE & HOSPITAL,
KURUNJIBAGH, SULLIA – 574 327.
3.
COURSE OF THE STUDY AND
: MASTER OF DENTAL SURGERY
ORTHODONTICS, BRANCH –V
SUBJECT
4.
DATE OF ADMISSION TO
:
2 MAY 2011
COURSE
COMPARATIVE
5.
TITLE OF THE TOPIC
EVALUATION
NASOPHARYNGEAL
CHARACTERISTICS
OCCLUSION
AND
OF
SOFT TISSUE
BETWEEN
CLASS
IDEAL
III
MALOCCLUSION IN DAKSHINA KANNADA
POPULATION.
6
BRIEF RESUME OF THE INTENDED STUDY
6.1 NEED FOR THE STUDY
The influence of the soft tissues on craniofacial growth has been discussed in the
orthodontic literature for many years. Since 1873 authors have studied airway obstruction
and its effects on malocclusion development.1-3
Because of the close relationship between the pharynx and the dentofacial structures, a
mutual interaction is expected to occur between the, pharyngeal structures and the
dentofacial pattern, and therefore justifies orthodontic interest. In many studies carried out
on this subject, it has been demonstrated that there are statistically significant relationships
between the pharyngeal structures and both dentofacial
and craniofacial structures at
varying degrees.4
It has been also suggested that skeletal class III with maxillary hypoplasia is a cause of
upper pharynx constriction.1 The effects of rapid maxillary expansion associated with
maxillary protraction on pharyngeal dimensions demonstrated that maxillary protraction
improves the nasopharyngeal airway dimensions.5,6
According to these facts it can be assumed that a skeletal class III malocclusion is associated
with an abnormal airway. There may be however significant differences in nasopharyngeal
soft tissue characteristics between Class I and Class III malocclusion in the ethnic
population of Dakshina Kannada .
Hence, this study will be done to evaluate the naso-pharyngeal soft tissue characteristics in
patients with Class III malocclusion and compare the results with Ideal Class I occlusion in
Dakshina Kannada population.
6.2 REVIEW OF THE LITERATURE:
A study was done to assess nasopharyngeal soft tissue characteristics in white
patients with class III malocclusion and to compare the results with patients with ideal
occlusion. Lateral cephalograms of 71 patients with Class III were digitized, and linear
and area measures were made to define the airway characteristics. The results showed
that adenoidal tissue and upper airway length were greater in men. From this study it
was suggested that there exists possible specific respiratory characteristics for each type
of malocclusion.1
A study was conducted to assess the separate associations of lip posture, sagittal airway
size, and tonsil size with selected cephalometric measures. Clinical and cephalometric data
of 207 patients who presented for evaluation of tonsil or adenoid problems were evaluated.
The results showed association of a more open lip posture with a more backwardly rotated
face and larger lower facial height. Also, reduced sagittal airway size was associated with
backward relocation of the maxilla and mandible. From this study it was concluded that lip
posture, sagittal airway size, and tonsil size represented three different and unrelated
phenomena with respect to their effects on craniofacial growth and form.7
An observational study was conducted to obtain normative data for cephalometric
measurements of the upper airway in the local Chinese population. Twenty cephalometric
airway measurements, including size of the tongue, soft palate, nasopharynx, oropharynx,
hypopharynx, and relative position of the hyoid bone and valleculae were obtained for a
sample of 74 healthy patients (29 males, and 45 females). The results showed significant sex
dimorphism for the majority of measurements, with the exception of minimal depth of the
airway, oropharyngeal depth of the airway, and the soft palate angle with the hard palate.
The study concluded that a minimum sagittal dimension of the upper airway was evident
despite differences in measurements between sexes.8
A study was done to investigate the uvulo-glosso-pharyngeal dimensions in subjects with
different anteroposterior jaw relationship. Cephalometric radiograph of 90 subjects (45
females and 45 males, aged ) were divided into three groups according to the ANB angle, ie,
group 1, skeletal Class I; group 2, skeletal Class II ; and group 3, skeletal Class III . In
addition, each group was divided into two subgroups according to sex. Results of the study
showed that sex differences were found in Class I and III subjects, no sex differences were
detected in Class II subjects. Anteroposterior skeletal pattern showed a weak, but significant
correlation with inferior pharyngeal airway space vertical position of hyoid bone in relation
to mandibular plane and anteroposterior position of hyoid bone in relation to. From this it
was concluded that uvulo-glosso-pharyngeal dimensions were affected by anteroposterior
skeletal pattern.9
In this study, whether upper airway dimensions differed among Chinese nonsnoring
subjects of different sagittal and vertical skeletal facial morphologies were analyzed. Sample
included two groups of subjects: A group of subjects with a normodivergent facial pattern (n
= 190), divided into three subgroups according to ANB angle (Class I, II, or III) and a
second group of subjects with a normal sagittal facial pattern (n = 180), divided into three
subgroups according to the FH-MP angle (low angle, normal angle, or high angle). The
results showed a significant tendency for reduced upper airway dimension in the inferior part
in the Class III, Class I, and Class II subgroups, in that order. Moreover, in the group of
subjects with a normal sagittal facial pattern, the superior part of the airway decreased with
increasing mandibular plane angle. From this it was concluded that the sagittal and vertical
skeletal patterns may be contributory factors for the variation of the inferior and superior
part of the upper airway, respectively.10
6.3 OBJECTIVES OF THE STUDY :
1.
To assess the nasopharyngeal characteristics in adults with ideal occlusion and Class
III malocclusion.
2.
To compare the nasopharyngeal characteristics in adults between ideal occlusion and
Class III malocclusion.
7. MATERIAL & METHODS
7.1 SOURCE OF THE DATA:
160 pre-treatment lateral cephalograms will be taken from the patients reporting to the
department of Orthodontics, KVG dental college and hospital, Dakshina Kannada ,
Karnataka.
MATERIALS REQUIRED:
 Lateral Cephalograms.
INCLUSION CRITERIA :


Patients with no previous orthodontic treatment.
Class I ideal occlusion and class III malocclusion.

Optimal periodontal health.

Patients native to Dakshina Kannada.
EXCLUSION CRITERIA:

Posterior cross-bite.

Craniofacial deformities.

Asymmetries.

Missing teeth.

History of sleep disorders , snoring , sleep apnea, upper airway disease ,
Adenoidectomy, pathology in the pharynx.
7.2 METHODOLOGY
Lateral cephalogram will be obtained from patients visiting the K VG dental college, Sullia ,
Dakshina Kannada. Lateral cephalogram will be traced manually. Thirteen cephalometric
measurements will be recorded. Difference in variables between patients with class III and
class I molar relation will be compared. The following cephalometric measurements will
be selected :
1 )PNS-AD1: Lower areal width, the distance between PNS and the adenoid tissue measured
through the PNS-Ba line (AD1).
2 )AD1-Ba: Lower adenoid width, defined as the soft tissue thickness at the posterior
nasopharynx wall through the PNS-Ba line.
3 )PNS-Ba: Lower airway width, the distance between PNS and Ba –the sum of variables 1
and 2.
4 )PNS-AD2: Upper aerial width, the distance between PNS and the nearest adenoid tissue
measured through a perpendicular line to S-Ba from PNS (AD2).
5 )AD2-H: Upper adenoid width, defined as the soft tissue thickness at the posterior
nasopharynx wall through the PNS-H line.
6 )Hormion (H): The cephalometric point located near the adenoidal tissue at the cranial
base, localized where a perpendicular to S-Ba line crosses the sphenoid bone .The variations
of this point are minimal because it is located far from growing sites.
7 )PNS-H: Upper airway width .the distance between PNS and H – the sum of variables 1
and 2.
8 )N-H: Nasal fossa length, the distance between N and H.
9 )S-N: Anterior cranial base.
10 )McNamara’s upper pharynx dimension: The minimum distance between the upper soft
palate and the nearest point on the posterior pharynx wall.
11 )McNamara’s lower pharynx dimension: The minimum distance between the point where
the posterior tongue contour crosses the mandible and the nearest point on the posterior
pharynx wall.
12 )Total, Adenoidal, Aerial areas – will be measured using the method of Handelman and
Osborne. This method takes as reference the Ba-N plane, the bispinal plane, and 2
perpendicular lines to the bispinal plane ; one crosses the more anterior point at the atlas
vertebrae , and other crosses the PNS . The resulting trapezoid is divided into 2 spaces
(aerial and adenoid).The total area is the sum of the adenoidal and aerial areas.
STATISTICAL ANALYSIS :
An independent means t- test, assuming equality of variances, will be used for all variables.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS
TO BE CONDUCTED IN PATIENTS OR OTHER HUMANS
YES
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION
HAS BEEN OBTAINED.
LIST OF REFERENCES:
1. Martin O, Muelas L, VinasMJ. Comparitive study of nasopharyngeal soft - tissue
characteristics in patients with class III malocclusion. Am J Orthod Denotofacial Orthop
2011;139:242-51.
2. Harvold EP, Chierici G, Vargervik K. Experiments on the development of dental
malocclusion. Am J Orthod 1972;61:38-44.
3. Ackermam JL. Soft tissue limitations in orthodontics: treatment planning guidelines.
Angle Orthod 1997;67:327-36.
4. Ceylan I, Oktay H. A study on the pharyngeal size in different skeletal patterns.Am J
Orthod Dentofacial Orthop 1995;108:69-75.
5. Kilinic AS, Arslan SG, Kama JD, Ozer T, Dari O. Effects on the sagittal pharyngeal
dimension of protraction and rapid palatal expansion in class III malocclusion subjects.
Eur J Orthod 2008;30:61-6
6. Sayinsu K, Isik F, Arun T. Sagittal airway dimension following maxillary protraction : a
pilot study. Eur J Orthod 2006;28:184-9
7. Trotman CA, McNamara JA , Dibbets JMH , Vanderweele LT. Association of lip
posture and the dimensions of the tonsils and sagittal airway with facial
morphology.Angle orthod 1997;67: 425-432.
8. Samman N, Mohammadi H , Xia J. Cephalometric norms for the upper airway in a
healthy Hong Kong Chinese population. Hong Kong Med J 2003:9:25-30.
9. Allhaja AES, Al Khateeb SN. Uvulo-glosso-pharyngeal dimensions in different
anteroposterior skeletal patterns. Angle Orthod 2005 Nov;75(6):1012-8.
10. Zhong Z, Tang Z, Gao X, Zeng XL. A comparison study of upper airway among
different skeletal craniofacial patterns in nonsnoring Chinese children. Angle Orthod
2010 Mar;80(2):267-74.
9.
SIGNATURE OF CANDIDATE
10.
REMARKS OF THE GUIDE
11.
NAME AND DESIGNATION OF
11.1 GUIDE
DR MAHESH KUMAR Y, MDS
PROFFESSOR,
DEPT
OF
ORTHODONTICS
DENTOFACIAL ORTHOPAEDICS
AND
11.2 SIGNATURE
11.3 HEAD OF THE DEPARTMENT
DR. SHARATH KUMAR SHETTY, M.D.S.
DIRECTOR OF PG STUDIES,
PROFESSOR AND HOD,
DEPARTMENT OF ORTHODONTICS AND
DENTOFACIAL ORTHOPAEDICS,
K.V.G DENTAL COLLEGE AND HOSPITAL,
KURUNJIBAGH, SULLIA, D.K -574327
11.4 SIGNATURE
12.
REMARKS OF THE PRINCIPAL
DR. MOKSHA NAYAK, M.D.S.
PRINCIPAL,
K.V.G. DENTAL COLLEGE AND HOSPITAL,
KURUNJIBAGH, SULLIA.
12.1 SIGNATURE