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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
Name of the candidate
Dr .Abdul Kareem
Address
Post Graduate Student,
Department of Orthodontics and
Dentofacial Orthopedics,
KLE Society’s Institute Of Dental Sciences,
# 20,Yeshwantpur Suburb,
Tumkur Road , Bangalore -22
2.
Name of the institution
KLE Society’s Institute of Dental Sciences
Bangalore -22
3.
Course of the study and subject
Master of Dental Surgery in Orthodontics and
Dentofacial Orthopedics.
4.
Date of admission of course
5.
Title of the topic:
20th April 2009
Dental Arch Width And Vertical Facial
Morphology Correlation –A Cephalometric and
Study Model Analysis in Untreated Adults.
1
6
BRIEF RESUME OF INTENDED WORK
6.1 NEED FOR THE STUDY
Each individual is a different person in this world, no one is similar with the
other in any way, and so is the case with facial morphology. Facial morphology
is influenced by various factors like genetic, racial, ethnic geographical etc. But
each type of face has a proportion of its own, intern the facial morphology is
closely related to the size and shape of the dental arches.
Hence in orthodontics for proper diagnosis and treatment planning it is
necessary to know the facial morphology of each patient which intern can
influence the treatment plan.
There is a proportion between each dimension of the face , as the long face
individual has narrower transverse dimensions (dolichofacial) and a short face
individual has wider transverse dimensions (brachyfacial).1
In daily clinical practice, preformed arch wires are routinely used by many
orthodontists. So there is a need to correlate different arch width with vertical
facial morphology. The relationship of the Dental arch width and the vertical
facial morphology in male and female subjects will help in using better
treatment mechanics for stable treatment results 2.
The purpose of the present study is to correlate the dental arch widths and
vertical facial morphology as determined by the percentage of posterior facial
height(S- Go) to anterior facial height (Na-Me)3 and to examine the differences
in dental arch widths and vertical facial morphology between male and female
untreated adults.
2
6.2 REVIEW OF LITERATURE:
1. Wei SH
4
conducted a study in 1970 to obtain a data of variations in
craniofacial dimensions in Chinese population; he used posteroanterior
cephalograms of Chinese adults and noted gender differences in maxillary
and mandibular intercanine widths.
2.
Isaacson J R, Isaacson R J, Speidel T M, Worms F W 5 in 1971 conducted
a study to know the extreme variations in vertical facial growth and
associated variation in skeletal and dental variations. They reported that
subjects with longer faces presented with a decrease in maxillary intermolar
width. However, they did not distinguish between males and females.
3. Nasby J A , Isaacson R J , Worms F W , Speidel T M 6 in 1972 conducted a
study to evaluate the relationship between facial skeletal patterns and dental
occlusion. They reported that the mean maxillary and mandibular arch
circumference and mandibular intermolar width were greater in subjects
with low MP – SN angles when compared with those with high MP – SN
angles. In their study, the subjects were adolescents without discussion of
gender and ethnicity.
4.
Schendel SA, Eisenfeld J, Bell WH, Epker BN, Mishelevich DJ
7
in 1976
they studied 31 patients with long face syndrome .On the basis of the
clinical summary ofs this syndrome, an analysis of esthetics, skeletal
morphology, and occlusion was undertaken. They concluded that the basic
dentofacial deformity is associated with excessive vertical growth of the
maxilla. Dental open and closed bite are two variants of the syndrome. An
increased mandibular ramus height is associated with the closed-bite group.
5. Christie T E 8 in 1977 evaluated orthodontic records of 82 white adults (43
women, 39 men) with normal untreated occlusions and found that short-face
men had greater maxillary and mandibular widths than normal men.
However, no differences in width were found between short-face and
normal women. They did not provide data on long-face subjects because the
sample size was too small (only 4).
3
6. Tsunori M , Mashita M , Kasai K
9
in 1998 reported that, when compared
with average and long-face persons, short-face subjects had larger
intermolar widths and greater buccal cortical bone thicknesses in the molar
area of the mandible. They suggested a possible link between the
development of the maxillofacial complex in the vertical and transverse
dimensions and measures of increased muscularity.
7.
Eröz UB, Ceylan I, Aydemir S 10 in 2000 has done a study to investigate the
mandibular morphology in different vertical facial growth patterns.
Mandibular morphology was investigated on lateral cephalometric head
films and dental casts of 60 subjects (30 females and 30 males) who had
different vertical facial growth patterns. The sample had a mean age of 13.5
years, with a range of 11 to 15.5 years. The subjects were divided into three
groups with regard to vertical facial growth by using the SN/GoGn angle to
define low-angle, normal, and high-angle groups. In addition, each group
was divided into two subgroups according to sex. The effects of the
SN/GoGn angle and gender on mandibular morphology were investigated
by means of analysis of variances. Than Go, IMPA, SL, and EL
measurements were found to be related to SN/GoGn, and the measurements
of Go-Gn, Symphysis depth, and Intermolar width to be related to sex.
8.
Chun-Hsi Chung, Wallace W. Wong
11
in 2002 conducted a longitudinal
study to investigate the craniofacial growth in untreated skeletal class II
subjects. They concluded that the low-angle group displayed significantly
more facial flattening and more mandibular forward rotation than did the
high-angle group. Moreover, the mandibular incisors became more
retroclined in the low-angle group and more proclined in the high-angle
group with age. Comparisons between males and females showed similar
skeletal growth patterns in angular measurements. However, a significant
sex difference was noted in some linear measurements.
4
9. Chung CH, Mongiovi VD12, conducted a longitudinal study in 2003 to
investigate the craniofacial growth in untreated skeletal class I subjects with
low, average, and high MP_SN angles. Results showed that, for boys and
girls at age 9, the low-angle groups exhibited significantly larger SNA
angle, SNB angle, facial taper, PFH, PFH:AFH, and ramus height, and the
high-angle groups showed significantly larger ANS-Me and gonial angle.
From ages 9 to 18, all the male and female low-, average-, and high-angle
groups showed an increase in SNA and SNB angles, and PFH: AFH, and a
decrease in ANB angle, convexity (more flattened face), MP-SN angle, and
gonial angle (mandibular forward rotation). The dental measurements
showed few changes with growth in all groups. In terms of skeletal
measurements from ages 9 to 18, similar growth changes were found
between the sexes in most angular measurements, but males had larger
values in linear measurements than females.
10. Dawn M. Wagnera and Chun-Hsi Chung13 in 2005 conducted a study on 81
untreated white girls with low, average and high MP-SN angels to
investigate the maxillary and mandibular transverse growth longitudinally
from ages 6 to 8 years. For each subject, longitudinal posteroanterior
cephalograms at different ages (from ages 6 to 18) were traced, and the
widths of maxilla and mandible were measured. They concluded that the
vertical facial patterns (with low or high mandibular plane angles) might
play a strong role in the transverse growth of the maxilla and the mandible.
5
11. C. Matthew Forster, Elaine Sunga and Chun-Hsi Chung2 in 2008 conducted
a study to know the relationship between dental arch width and vertical
facial morphology in untreated adults. Lateral cephalograms and dental casts
were obtained from 185 untreated Caucasians (92 males, 93 females)
between 18 and 68 years of age with no crossbite, minimal crowding, and
spacing. MPSN angle is measured.Dental casts were used to obtain
comprehensive dental measurements including maxillary and mandibular
intercanine, interpremolar, and intermolar widths, as well as the amount of
crowding or spacing.. Regression analysis was used to determine the
statistical significance of the relationships between MP – SN angle and
dental arch width and crowding or spacing. The results showed that male
arch widths were significantly larger than those of females. For both males
and females, there was a trend that as MP – SN angle increased, arch width
decreased. It was
concluded that dental arch width is associated with
gender and facial vertical morphology. Thus, using individualized archwires
according to each patient’s pre-treatment arch form and width is suggested
during orthodontic treatment.
6.3 AIMS AND OBJECTIVES OF THE STUDY:
The objectives of this study is to
1. Correlate between dental arch width and the vertical facial pattern.
2.
Evaluate the differences in dental arch widths and vertical facial
morphology between male and female untreated adults
6
7
MATERIALS AND METHODS
7.1 Source of data:
Data will be collected from the patients reported to Department of
Orthodontics and Dentofacial Orthopedics, K.L.E society’s Institute of Dental
Sciences Bangalore.
Venue: This study will be conducted in Department of Orthodontics and
Dentofacial Orthopedic, KLE society’s institute of dental sciences Bangalore.
7.2 Method of collection of data:
Type of study
- Descriptive study
Sample size
- 100
Age Group
- 18-25
Sampling Method
- Sample will be Randomly selected ,and for
descriptive purposes, the subjects will be classified into three different groups
according to percentage Facial height ratio3:
1. hypo divergent 64-80%
2. neutral
59-63%
3. Hyper divergent 54-58%.
INCLUSION CRITERIA 2

Full dentition with / or without third molars.

Dentition with good periodontal health.

No history of previous orthodontic treatment
EXCLUSION CRITERIA
2

Previous orthodontic treatment.

Edentulous spaces.

History of trauma.

Significant cuspal wear.

Extensive restorations or prosthetics

Anterior and posterior cross bites

Severe crowding or spacing.
7
MATERIALS:

Pre-treatment lateral cephalogram .

Pre-treatment Maxillary and mandibular dental casts.
MEASUREMENTS:
For each subject following cephalometric and study cast measurement will be
done
.
CEPHALOMETRIC MEASURMENTS
1. Anterior facial height (AFH ) measured from Nasion to Menton (N-Me) 3
2. Posterior facial height ( PFH ) measured from Sella to Gonion(S-Go)3
3. Ramus height is measured from Condylion to Gonion (Go-Co)5
4. Palatal height is a perpendicular measurement from occlusion plane through
the mesial cusp of maxillary molor to inferior cortex of the palate (Op-Pp)5.
5. Facial height ratio (PFH/AFH) 3
6. Ratio of Ramus height to palatal height.
DENTAL CAST MEASUREMENTS
Will be performed using a digital caliper accurate to 0.01mm.
The following maxillary and mandibular dimensions will be measured
1. Intercanine width (cusp tip and widest labial aspect)2.
2. First and second interpremolar widths (buccal cusp tip
and widest buccal aspect)2.
3. First intermolar widths (mesiobuccal cusp, central fossa,
widest buccal, and narrowest lingual aspect)2.
8
STATISTICAL TESTS THAT WILL BE USED
Descriptive statics, including mean and SD, will calculated for all
measurements.

A student’s two tailed t test will be use to determine if the differences in
male and female groups are significant.

Regression analyses will be used to determine the percentage to which
Facial height ratio variation will be predicted by dental arch width in male
and females separately.
7.3 Dose the study require any investigation or interventions to be conducted on
Patients or other humans or animals? If so please describe briefly
No
7.4 Has ethical clearance be obtained from your institution in case of 7.3?
Not applicable
9
LIST OF REFERENCES
1. Ricketts R M , Roth R H , Chaconas S J , Schulhof R J , Engel G A 1982
Orthodontic diagnosis and planning . Rocky Mountain Data Systems ,
Denver
2.
Foster C.M, Sunga E Chung CH :Relationship between dental arch width
and vertical facial morphology in untreated adults.
Eur J Orthod 30 (2008) 288–294.
3. Siriwat PP, Jarabak JR 1985; maloclussion and facial morphology is there
a relationship? Angle Orthod 55: 127-138
4. Wei S H 1970 Craniofacial width dimensions. Angle Orthod 40 :
141 – 147
5.
Isaacson J R , Isaacson R J , Speidel T M , Worms F W 1971 Extreme
variation in vertical facial growth and associated variation in skeletal
And dental variations. Angle Orthod 41 : 219 – 230
6. Nasby J A , Isaacson R J , Worms F W , Speidel T M 1972 Orthodontic
Extractions and facial skeletal pattern . Angle Orthod 42 : 116 – 122
7.
Schendel S , Einsfeld J , Bell W 1976 The long face syndrome: vertical
Maxillary excess. Am J Orthod 70 : 398 – 408
8.
Christie T E 1977 Cephalometric patterns of adults with normal occlusion.
Angle Orthod 47 : 128 – 135
9.
Tsunori M , Mashita M , Kasai K 1998 Relationship between facial types
and tooth and bone characteristics of the mandible obtained by CT
Scanning. Angle Orthod 68 : 557 – 562
10
10
Eroz U B , Ceylan I , Aydemir S 2000 An investigation of mandibular
Morphology in subjects with different vertical facial growth patterns.
Aust Orthod J 16 : 16 – 22
11.
Chung C-H , Wong W W 2002 Craniofacial growth in untreated in Class II
subjects: a longitudinal study
Am J Orthod Dentofacial Orthop122 : 619 – 626
12.
Chung C-H , Mongiovi V D 2003 Craniofacial growth in untreated
Skeletal Class I subjects with low, average, and high MP-SN angles: a
longitudinal Study. Am J Orthod and Dentofacial Orthop 124 : 670 – 678
13
Wagner D C , Chung C-H 2005 Transverse growth of the maxilla and
mandible in untreated girls with low, average, and high MP-SN angles:
a longitudinal study. Am J Orthod and Dentofacial Orthop 128 : 716 – 723
14. Proffi t W R 2000 Contemporary orthodontics. Mosby , St. Louis
11
9.
SIGNATURE OF CANDIDATE
10.
REMARKS OF THE GUIDE
11.
Satisfactory
NAME AND DESIGNATION OF
DR.B.C KARUNAKARA
PROFESSOR
DEPARTMENT OF ORTHODONTICS AND
DENTOFACIAL ORTHOPEDICS.
(IN BLOCK LETTERS)
11.1 GUIDE
11.2 SIGNATURE
DR.S.E.SHEKAR
PRINCIPAL , PROFESSOR & HOD
DEPARTMENT OF ORTHODONTICS AND
DENTOFACIAL ORTHOPEDICS.
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 HEAD OF THE
DEPARTMENT
DR.S.E.SHEKAR
PRINCIPAL , PROFESSOR & HOD
DEPARTMENT OF ORTHODONTICS AND
DENTOFACIAL ORTHOPEDICS.
11.6 SIGNATURE
12.
12.1 REMARKS OF THE
Can be done
CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE
12
13