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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