Download Comparison of Incisor, Molar and Anterior Facial Height in Normal

10.5005/jp-journals-10021-1111
RESEARCH ARTICLE
AM Deoghare et al
Comparison of Incisor, Molar and Anterior
Facial Height in Normal, Angle Class II
Division 1 and Class III Malocclusion:
A Cephalometric Study
1
AM Deoghare, 2Pankaj Akhare, 3Rohit Patil, 4Amanish Singh Shinh
ABSTRACT
Objective: The purpose of this study was to compare incisor, molar and anterior facial height in normal, Angles Class II Division 1 and Class III
malocclusion on lateral cephalograms.
Materials and methods: Sample consisted of total 60 lateral cephalograms of the patients between the age of 16 and 32 years comprised of 20
each of normal, Angles Class II Div 1 and Class III malocclusion.
Results: After studying specific landmarks and planes in the cephalograms, it was concluded that anterior facial height is significantly small in
Class II Div 1, compared to normal and Class III. A fair degree of constancy of upper and lower face heights has been found in the study. It was
also found that the upper molar height is contributory to increase and decrease in vertical proportions of face. Lower molar height can be related
to the degree of overbite in Class II Div 1 case.
Keywords: Incisor height, Molar height, Anterior facial height.
How to cite this article: Deoghare AM, Akhare P, Patil R, Shinh AS. Comparison of Incisor, Molar and Anterior Facial Height in Normal, Angle
Class II Division 1 and Class III Malocclusion: A Cephalometric Study. J Ind Orthod Soc 2012;46(4):304-307.
INTRODUCTION
From the time immemorial, men have sought to solve the riddle
of facial beauty and harmony through measurements and
geometry. No part of human anatomy arouses so much interest
as the face.
The most difficult diagnosis, because it is the least
subjective, is that of esthetic balance of face. The sense of
beauty is one acquired by education and environment.
Therefore, it is variable with the same individual at different
times and among individuals as it is related to geographic and
cultural variations.
Soon after orthodontics was established to be a specialty,
men attempted to classify malocclusions for better understanding and communication. Earlier classifications, which are
still widely used, are defined in only the antero-posterior plane
1
Professor and PG Guide, 2Assistant Professor, 3Postgraduate Student
(2nd Year), 4Professor and Head
1-3
Department of Orthodontics and Dentofacial Orthopedics, VSPM’s
Dental College and Research Centre, Nagpur, Maharashtra, India
4
Department of Orthodontics, Adesh Institute of Dental Sciences and
Research, Bathinda, Punjab, India
Corresponding Author: AM Deoghare, Professor and PG Guide
Department of Orthodontics and Dentofacial Orthopedics, VSPM’s Dental
College and Research Centre, Nagpur-440059, Maharashtra, India
e-mail: [email protected]
Received on: 24/9/11
Accepted after Revision: 22/7/12
304
as this was supposed to be the balance of dentofacial complex.
However, many anteroposterior imbalances are only
symptoms, the cause of which is found in the vertical dysplasia.
Introduction of roentgenographic cephalometrics by HB
Broadbent1 opened a new era in the field of orthodontics, prior
to which, orthodontists had mainly to depend upon study casts
clinical and intraoral periapical radiographic examination for
diagnosis and treatment planning.
Vertical measurements in cephalometric analysis have
received little attention because of large number of horizontal
measurements, and few studies have been devoted directly to
facial esthetics that would enable a person to distinguish which
dimensions of face and teeth are responsible primarily for a
pleasant or an unpleasant face. However the vertical
relationships of jaws with the rest of the face have obvious
clinical importance in cases of severe open bite and cases of
deep bite.
The present study was done to compare, with the aid of
cephalometry, the tooth height and anterior facial height in
skeletodental retrognathic (Angle Class II) skeletodental
prognathic (Angle Class III) and orthognathic (normal
occlusion) cases, as these heights are directly responsive to
treatment influences.
MATERIALS AND METHODS
The sample for the present study comprised of a total of 60
lateral cephalograms. These were obtained from the records
of the Orthodontic Department, Government Dental College,
JAYPEE
JIOS
Comparison of Incisor, Molar and Anterior Facial Height in Normal, Angle Class II Division 1 and Class III Malocclusion
Fig. 1: Anterior facial height and its components
Fig. 2: The spina palatal plane
Fig. 4: The measurement method of tooth heights
2. The tip of the lower central incisor and the center of the
chewing surface of first permanent molar.
3. The spina palatal plane.
4. The mandibular plane.
5. The perpendicular distances from incisors and molars to
the respective planes in the jaws.
Following landmarks and planes were used for the study
of anterior facial height:
1. Anterior nasal spine (ANS)
2. Gnathion (Gn)
3. Posterior nasal spine (PNS)
4. Pterygomaxillary (Ptm)
Planes used are as follows:
1. Palatal plane (pp)
2. The occlusal plane
3. The anterior skeletal plane (ASP)
RESULTS
Fig. 3: The mandibular plane
Bombay. The cephalogram comprised of 20 each of normal,
Angle Class II Division 1 and Class III malocclusion. The
sample was chosen at random. The age of the patients whose
cephalograms were selected ranged from 16 to 32 years.
Following landmarks and planes were used in the study:
Landmarks and Planes for the Study of
Tooth Height’s (Figs 1 to 4)
For the study of incisor and molar heights, following landmarks
and planes were used:
1. The tip of the upper central incisor and the center of the
chewing surface of first permanent molar.
Following results have been drawn from the comparison of
tooth heights and anterior facial height in normal Angle’s
Class II Division 1 and Class III cases.
1. Vertical proportions of face are quite variable and the total
anterior facial height in Class II Division 1 is significantly
less when compared to normal and Class III (Graph 1).
2. It is also found that lower facial height is significantly small
in Class II Division 1 compared to normal and Class III
cases (Graph 2).
3. Mean values found for the maxillary component of lower
facial height were also found to be statistically significant
when normal and Class II Division 1 and Class II Division
1 and Class III were compared (Graph 3).
4. Mean values of the mandibular component of lower facial
height have been found to be statistical significant when
normal and Class II Division 1 and Class II Division 1 and
Class III were compared (Graph 4).
5. When comparing the tooth heights, maxillary molar height
was found to be significant when normal and Class II
Division 1 and Class II Division 1 and Class III were
compared. It can be, therefore, concluded that maxillary
molars contribute to the increase or decrease in vertical
The Journal of Indian Orthodontic Society, October-December 2012;46(4):304-307
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AM Deoghare et al
Graph 1: Total anterior facial height of Class II Division 1 is less as
compared to normal and Class III malocclusion
Graph 2: Lower anterior facial height is less in Class II Division 1 as
compared to normal and Class III malocclusion
Graph 3: Lower anterior facial height is statistically significant when
compared with Class II Division 1, normal and Class III malocclusion
Graph 4: Lower anterior facial height is statistically significant when
compared with Class II Division 1, normal and Class III malocclusion
proportions. Also, lower molar height was found to be
significant in normal and Class II Division 1. This can be
contributory factor in the causation of deep bite.
Because the relative heights of teeth are directly
responsive to treatment influences, a thorough evaluation of
these should be done in diagnosis and treatment planning.
planning of treatment for Indian patients as these changes due
to a number of factors like racial variations, genetics, nutrition
body built and environment, etc.
Sheshadri5 calculated a figure of 109.95 mm in his study
of Gujarati girls. The present mean value indicates that vertical
proportions of face are variable even among subjects with
Class II division 1 and that Gujarati females have short face
compared to the normal value obtained in the present day.
The mean value for lower facial height (P-Gn) obtained in
the present study is 67.65 mm for normal, 61.43 mm for
Class II division 1 and 71.46 mm for Class III subjects. Jalali6
calculated a figure of 67.83 mm in adults with normal
occlusion. The value obtained in the present study is close to
the one found out by him.
Mathur7 reported mean values of 59.96 and 60.63 mm
respectively for Gujarati and Maharashtrian girls with normal
occlusion. When compared to the mean value in the present
study, it is observed that Gujarati and Maharashtrian girls have
a shorter lower face heights.
Mean value obtained for the maxillary component of lower
facial height in normal, Angles Class II Division 1 and Class III
DISCUSSION
Any biologic entity is a variable and homosapiens are no
exception to it. The vertical proportions of face are of
importance from diagnosis and treatment planning point of
view. Herzberg2 and Herbert3 have stressed the importance of
facial proportions in the vertical plane. As, according to
Sassouni4 and Nanda, anteroposterior imbalances are only the
symptoms the cause of which is found in the vertical dysplasia.
There have been some cephalometric studies which gave
only a cursory look at the study of face and dentition heights.
On the other hand, normal subjects have been studied
thoroughly in Western countries and standards laid down for
them. These standards cannot be utilized for assessment and
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Comparison of Incisor, Molar and Anterior Facial Height in Normal, Angle Class II Division 1 and Class III Malocclusion
were 26.23, 23.58 and 27.28 mm respectively. These values
were found to be statistically significant when normal
occlusion and Class II Division 1 and Class III were compared.
This shows that the height of the maxillary component in
Class II Division 1 is less compared to normal and Class III.
Mean values obtained for the mandibular component of
lower facial height were 40.93, 37.40 and 44.20 mm for
normal, Class II Division 1 and Class III respectively. These
values found to be statistically significant when Normal and
Class II Division 1, Class II Division 1 and Class III were
compared from this, it is observed that the heightwise growth
of mandible is less in Class II Division 1 cases. Mean value
for Class III is more than that of the normal but not statistically
significant.
Percentage of lower and upper facial heights in the present
study have been found to be 53.69 and 46.39 in normal, 52.9
and 47.1 for Class II Division 1 and 56.05 and 43.95 for
Class III. According to Wylie,8 lower face height should be
56.81%. The values obtained in the present study for normal
is less than Wylie’s findings meaning thereby that Indians have
smaller lower face height compared to the western population.
However, it is found that there is a fair degree of constancy
of upper to lower face heights, especially the upper face height
in all the three group studied. Broadbent1 states that after the
pattern of face is established at the completion of deciduous
dentition, there is no marked change in the proportions of face
thereafter. However, Krogman11 proposes variation rather than
constancy to be the rule, which has been found in the present
study.
Mean values for dentition heights in normal were 28.60
and 42.95 mm for upper and lower incisor and 24.76 and
34.55 mm for upper and lower molars respectively. These
values are close to the values established by Shaikh9,12,14 who
found these to be 26.81 and 42.11 mm for upper and lower
incisors, and 21.74 and 32.93 mm for upper and lower molars
respectively.
It has been a significant finding to note that the height of
upper molar was found to be highly significant when normal
and Class II Division 1 and Class III mean values were
compared. It means, therefore, that upper molar height
contributes to the increase or decrease the vertical proportion.
In the present study, when normal and Class II Division 1
mean values were compared, lower molar height was found to
be significant. Prem Prakash and Margolis10 found that the
degree of overbite is related to upper and lower molar heights,
which concomitantly has been a finding in the present study
as cases with Class II Division 1 which invariably present
themselves with deep bite.
From the study, it was confirmed that vertical proportions
of face are quite variable. Dentition heights can be used to
diagnose the anomalies in the vertical height of denture like
open and deep bite. Also, according to some workers, the relative
vertical heights of teeth are directly responsive to treatment
influences13 and, hence, a thorough evaluation of these should
be done in diagnosis and treatment planning.
CONCLUSION
The study showed that the vertical proportions of face are quite
variable. It was found that anterior face height is significantly
small in Class II Division 1 compared to normal and Class III.
A fair degree of constancy of upper and lower face heights
has been found in the study, it was also found that the upper
molar height is contributory to increase and decrease in the
vertical proportions of the face. Lower molar height can be
related to the degree of overbite in Class II Division 1 cases.
REFERENCES
1. Broadbent BH. A new ray technique. Angle Ortho 1931;1:
45-66.
2. Herzberg F, Holic R. An Anthropological study of face height.
Am J Oral Surgery 1943;29:90-100.
3. Herbert AL. A cephalometric radiographic evaluation of face
height in adult males with excellent occlusion of teeth. Am J
Orthodon 1956;42:794.
4. Sassouni VA. Roentgenographic cephalometric analysis of cephalofacial- dental relationships. Am J Orthodon 1955;41:736-64.
5. Sheshadri B. Cephalometric appraisal of facioskeletal patterns of
Gujrati girls exhibiting excellent occlusion and Class II Div 1
malocclusion, MDS Dissertation, University of Bombay 1960.
6. Jalali PV. Vertical dimensions of face and dentition. Dissertation
MDS. Orthodontia, University of Bombay 1966.
7. Mathur. A cephalometric comparison of skeletal and dental patterns.
In Guajarati and Maharashtrian girls exhibiting excellent occlusion.
Dissertation, MDS. Orthodontia, University of Bombay 1964.
8. Wylie W. Overbite and vertical facial dimensions in terms of
muscle balance. Angle Ortho 1944;14:13-17.
9. Shaikh HS. Frequency of various types of malocclusion amongst
orthodontic patients. J Ind Dent Assn 1960;1:51.
10. Prakash P, Margolis H. Dento-craniofacial relations in varying
degrees of overbite. Am J Orthodon 1952;38:657-73.
11. Krogman WM. Problem of timing in facial growth with special
reference to the period of change in dentition. Am J Orthodon
1951;37:253-55.
12. Shaikh HS. Incisor and molar heights: A cephalometric study. J
Ind Dent Assn 1967;39:36-39.
13. Williams BH. Craniofacial proportionality in a horizontal and
vertical plane: A study in norma lateralis. Angle Ortho 1953;23:
26-33.
14. Shaikh HS, Desai DH. Varieties of malocclusion among
orthodontic patients. J Ind Dent Assn 1966;38:1.
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