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10.5005/jp-journals-10021-1113 ORIGINAL ARTICLE Amit Kumar Khera et al Relationship between Dental Arch Dimensions and Vertical Facial Morphology in Class I Subjects 1 Amit Kumar Khera, 2Gulshan K Singh, 3Vijay P Sharma, 4Alka Singh ABSTRACT Introduction: A well-balanced face has its good proportions in all three dimensions of space, i.e. transverse, sagittal and vertical. The vertical proportions of the face are important in determining the esthetics and harmony of the face. The objectives of this study were to evaluate the relationship between dental arch dimensions and the vertical facial pattern determined by the Jarabak ratio, and to examine the differences in dental arch dimensions between male and female untreated adults. Materials and methods: Lateral cephalograms and study models were obtained from 90 untreated subjects (45 males, 45 females) between 17 and 24 years of age with no crossbite, no/minimal crowding and spacing. The Jarabak ratio (posterior facial height/anterior facial height) was measured on cephalograms of each patient. Study models were used to obtain comprehensive dental measurements, including maxillary and mandibular cumulative mesiodistal width, intercanine, first interpremolar and first intermolar widths as well as arch perimeter, arch length, overbite, palatal height and curve of Spee. Results: The results showed that, for both males and females, there was a trend that as vertical facial height increased, arch width, arch perimeter and overbite decreased but palatal height and curve of Spee increased and males have significantly larger arch dimensions than those of females. Conclusion: It was concluded that dental arch dimensions were associated with facial vertical morphology and gender. Thus, using individualized archwires according to each patient’s pretreatment arch form and width is suggested during orthodontic treatment. Keywords: Normodivergent, Hypodivergent, Hyperdivergent, Arch dimensions. How to cite this article: Khera AK, Singh GK, Sharma VP, Singh A. Relationship between Dental Arch Dimensions and Vertical Facial Morphology in Class I Subjects. J Ind Orthod Soc 2012;46(4):316-324. INTRODUCTION An individual’s facial pattern may be considered as one of the key determinants of treatment selection because facial type influences the anchorage system, growth prediction of maxillofacial structures and goal of orthodontic treatment. Knowledge of arch forms is important for an orthodontist, as it is related to future growth and treatment outcome. However traditionally, change in the arch form has been analyzed in terms of the behavior of various linear dimensions, such as arch width, length and perimeter. Arch form has been defined as a linear formulation by Penrose1 as ‘form = size + shape’. The upper and lower dental arches can be considered 1 4 Senior Resident, 2Associate Professor, 3Former Head and Professor, Assistant Professor 1-4 Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Sciences, CSMMU (Upgraded KGMC), Lucknow Uttar Pradesh, India Corresponding Author: Amit Kumar Khera, Senior Resident, Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Sciences, CSMMU (Upgraded KGMC), Lucknow, Uttar Pradesh India, e-mail: [email protected] Received on: 21/1/12 Accepted after Revision: 8/5/12 316 as kind of flexible ribbons, adapted to varying jaw relationships to maintain normal relationship between dental arches for esthetic and function. The two extremes of vertical facial dysplasia have been described as hypodivergent and hyperdivergent by Schudy2 or short face syndrome (SFS) and the long face syndrome (LFS) by Opdebeeck.3 Hypodivergent subjects are characterized by a forward rotating mandible due to relatively large vertical condylar growth and small amount of vertical growth of alveolar process and/or anterior facial sutures. Hyperdivergent subjects are characterized by backward rotating mandible due to the opposite differential growth pattern. It is generally accepted among orthodontists that a relationship exists between dental arch width and vertical facial morphology. A long face (leptoprosopic) individual usually has narrower arch dimensions and a short face individual (euryprosopic) has wider arch dimensions according to Rickets et al.4 Nowadays, preformed archwires are routinely used by many orthodontists regardless of the facial type, facial proportions and gender of the patients. However, using individualized archwires according to each patient’s pretreatment arch form and width is suggested during orthodontic treatment. The present study was carried out in order to evaluate the relationship between dental arch dimensions and vertical facial pattern. JAYPEE JIOS Relationship between Dental Arch Dimensions and Vertical Facial Morphology in Class I Subjects The objectives of present study were as follows: 1. To evaluate the dental arch dimensions in different vertical-facial pattern. 2. To evaluate the correlation between dental arch dimensions and different vertical facial pattern. 3. To evaluate the differences in dental arch dimensions between male and female subjects. MATERIALS AND METHODS Sample The present study was conducted on 90 subjects comprising of 45 males (ranging from 18-24 years) and 45 females (ranging from 17-21 years) with a mean age of 20.53 ± 1.23 and 19.63 ± 1.06 years for males and females respectively. The lateral cephalograms and study models for the purpose of study were obtained from the records of patients visiting the outpatient department of the Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Sciences, CSM Medical University, Lucknow (UP), India. The subjects were selected on the basis of following inclusion and exclusion criteria: Inclusion Criteria 1. All permanent teeth should be present in each arch (3rd molar may or may not be present) and sufficiently erupted to permit measurement of mesiodistal crown dimensions. 2. Subjects with skeletal Class I pattern and Angle’s Class I molar relation having minimum/no crowding, spacing, rotation were selected. 3. No history of previous orthodontic treatment. 4. There should be no gross carious lesions or any proximal restoration, which can change the mesiodistal dimensions of arch. Exclusion Criteria 1. Subjects with craniofacial anomalies like cleft lip and palate and syndromes were not included in study. 2. Subjects with deleterious oral habits, like mouth-breathing, tongue thrusting and thumb sucking, were excluded. 3. Subjects with anterior and posterior crossbite were also excluded. 4. No history of trauma to dentofacial region. 5. Individuals with marked jaw asymmetries and temporomandibular joint (TMJ) abnormality were excluded from the study. Subjects were divided into two groups according to sex as follows: • Group I male (n = 45) • Group II female (n = 45) On the basis of Jarabak ratio (Table 1), group I male subjects were further subdivided into three subgroups, i.e. subgroup Ia (hypodivergent male), subgroup Ib (neutral/ normodivergent male) and subgroup Ic (hyperdivergent male). Similarly, group II female subjects were subdivided into three subgroups, i.e. subgroup IIa (hypodivergent female), subgroup IIb (neutral/normodivergent female) and subgroup IIc (hyperdivergent female). Measurements High quality orthodontic impressions for study models were taken with alginate impression material using rim lock impression trays. The lateral cephalograms of the selected subjects were taken using the standard technique employed in the Department of Orthodontics and Dentofacial Orthopedics, CSM Medical University (Erstwhile KGMC). The lateral cephalograms were traced on acetate tracing sheets, 0.5 micron in thickness using a sharp 4H pencil on a view box using transilluminated light in a dark room. For each subject, Jarabak ratio (Siriwat and Jarabak 1985)5 was measured. The posterior facial height was drawn from sella to gonion (Go) and anterior facial height was drawn from nasion to menton (Me). Study model measurements were performed using a Korkhaus three-dimensions caliper (Dentaurum) and digital caliper. The following maxillary and mandibular dimensions were measured (Figs 1 to 4): 1. Cumulative mesiodistal crown width [mesiodistal width of the crown at the greatest mesiodistal diameter of each tooth (Fig. 1)]. 2. Intercanine width [from buccal cusp tip (Fig. 2)]. 3. First interpremolar width [from buccal cusp tip (Fig. 2)]. 4. First intermolar width [from buccal, and lingual surface, (Fig. 2)]: The average of buccal and palatal/lingual widths were taken. 5. Arch length: From the contact point between the permanent central incisors to the line joining the distal surface of the permanent first molar (Fig. 2). 6. Palatal height: From the connecting line between the midpoint of the fissures of both upper first molars to the surface of the palate (see Fig. 2). Table 1: Distribution of subjects Groups Group I Male (n = 45) Group II Female (n = 45) Subgroups Hypodivergent (n = 40) Normodivergent (n = 30) Hyperdivergent (n = 20) Jarabak ratio (64-80%) Jarabak ratio (59-63%) Jarabak ratio (54-58%) Subgroup Ia (n = 20) Subgroup Ib (n = 15) Subgroup Ic (n = 10) Subgroup IIa (n = 20) Subgroup IIb (n = 15) Subgroup IIc (n = 10) The Journal of Indian Orthodontic Society, October-December 2012;46(4):316-324 317 Amit Kumar Khera et al Fig. 1: Mesiodistal width measurement by digital caliper Fig. 4: Measurement of curve of Spee 9. Overbite: Vertical distance between the incisal tips of maxillary and mandibular central incisors (Fig. 3). 10. Curve of Spee: Perpendicular distance between the deepest buccal cusp tips and a scale that was laid on the top of the mandibular dental cast (Fig. 4). Korkhaus three-dimensional caliper was used to measure the parameters: Arch length, intercanine width, first interpremolar width, first intermolar width and palatal height, while the mesiodistal crown width was measured with digital caliper and overjet, overbite and curve of Spee were measured with scale and divider. STATISTICAL ANALYSIS Fig. 2: Arch length, arch width and palatal height measurement by Korkhaus caliper Arch dimensions were evaluated using 16 linear parameters. Six maxillary, six mandibular and four other parameters were measured over the maxillary and mandibular study models. The data so obtained was subjected to the statistical analysis using statistical package program STATA version 10.2. Descriptive statistics, including the mean and standard deviation values, were calculated for all the parameters in each group. Student t-test was used to determine the significant differences between the mean and standard deviations of various parameters in the male and female groups. Subgroups of both groups were compared using one way analysis of variance (ANOVA) followed by Bonferroni post-hoc test. RESULTS Fig. 3: Measurement of overbite and overjet 7. Arch perimeter: Using formula 2 2 2 Y (4 x /3) given by Mills and Hamilton (1965).6 8. Overjet: From the labial surface of the lower incisor to the incisal edge of the upper incisor (Fig. 3). 318 The arch dimension measurements of hypodivergent, normodivergent and hyperdivergent subgroups of male and female were shown in Table 2 (Figs 5A to C) and Table 3 (Figs 6A to C) respectively. The hypodivergent subgroup had larger arch dimensions than hyperdivergent subgroup for most of measurements except for palatal height and curve of Spee which were larger in hyperdivergent subgroup. The mean of maxillary and mandibular first interpremolar width, first intermolar width, arch perimeter and overbite were decreased from hypodivergent to hyperdivergent but palatal JAYPEE JIOS Relationship between Dental Arch Dimensions and Vertical Facial Morphology in Class I Subjects Table 2: Comparison of arch dimension measurements between hypodivergent (subgroup Ia), normodivergent (subgroup Ib) and hyperdivergent (subgroup Ic) of Group I (male) Parameters Maxillary parameters 1. Cumulative mesiodistal crown width (TTM) 2. Intercanine width 3. First interpremolar width 4. First intermolar width 5. Arch length 6. Arch perimeter Subgroup Ia (n = 20) Subgroup Ib (n = 15) Subgroup Ic (n = 10) ANOVA p-value Mean ± SD Mean ± SD Mean ± SD 90.34 + 5.63 89.6 + 3.60 90.27 + 3.75 0.915 37.13 + 2.53 44.60 + 2.50 49.23 + 2.30 37.02 + 2.23 65.20 + 2.79 35.31 + 1.60 42.38 + 1.80 47.19 + 1.36 35.88 + 2.06 63.00 + 2.38 34.89 + 1.76 41.56 + 3.05 46.84 + 1.93 37.7 + 1.79 61.43 + 2.09 p-value Ia vs Ib Ia vs Ic Ib vs Ic 1.00 1.00 1.00 0.002** 0.005** 0.003** 0.110 0.002** 0.045* 0.044* 0.019* 0.403 0.058 0.038* 0.010** 0.014* 1.00 0.002** 1.00 1.00 1.00 0.131 0.601 Mandibular parameters 1. Cumulative mesiodistal crown width (TTM) 2. Intercanine width 3. First interpremolar width 4. First intermolar width 5. Arch length 6. Arch perimeter 82.19 + 4.59 83.59 + 2.40 82.41 + 3.01 0.562 0.893 1.00 1.00 27.43 + 1.84 36.17 + 1.88 45.60 + 1.58 32.52 + 2.29 59.03 + 2.28 25.31 + 1.83 34.65 + 1.91 43.81 + 2.36 31.77 + 2.39 57.07 + 2.62 25.14 + 1.59 33.72 + 2.46 42.54 + 2.69 33.56 + 1.24 56.6 + 2.60 0.004** 0.009** 0.002** 0.102 0.022* 0.05* 0.123 0.064 0.403 0.092 0.010** 0.013* 0.002** 1.000 0.050* 0.082 0.883 0.519 0.131 1.000 Other parameters 1. Overjet 2. Overbite 3. Palatal height 4. Curve of Spee 2.20 + 0.92 2.82 + 1.06 21.10 + 3.06 1.91 + 0.61 2.12 + 1.08 2.35 + 1.07 22.00 + 2.55 2.04 + 0.72 1.89 + 0.89 1.78 + 0.51 24.33 + 2.45 2.59 + 0.22 0.272 0.033* 0.022* 0.022* 1.00 0.526 1.000 1.00 1.00 0.032* 0.019* 0.020* 1.00 0.558 0.183 0.115 p-value: > 0.05 nonsignificant; *:<0.05 just significant; **: <0.01 moderately significant Table 3: Comparison of arch dimension measurements between hypodivergent (subgroup IIa), normodivergent (subgroup IIb) and hyperdivergent (subgroup IIc) of Group II (female) Parameters Maxillary parameters 1. Cumulative mesiodistal crown width (TTM) 2. Intercanine width 3. First interpremolar width 4. First intermolar width 5. Arch length 6. Arch perimeter Subgroup IIa (n = 20) Mean ± SD Subgroup IIb (n = 15) Mean ± SD Subgroup IIc (n = 10) Mean ± SD ANOVA p-value p-value IIa vs IIb IIa vs IIc IIb vs IIc 87.94 + 3.71 89.9 + 3.32 88.73 + 5.77 0.704 1.00 1.00 1.00 34.60 + 1.83 42.4 + 2.51 46.6 + 2.86 36.48 + 2.72 62.86 + 2.20 34.40 + 1.68 42.7 + 2.40 45.5 + 1.30 36.53 + 2.56 62.97 + 3.32 34.05 + 1.83 40.00 + 2.40 44.50 + 1.53 35.30 + 3.50 60.08 + 2.91 0.728 0.024* 0.048* 0.508 0.024* 1.00 1.00 0.442 1.000 1.000 1.000 0.041* 0.050* 0.883 0.039* 1.000 0.028* 0.803 0.889 0.043* Mandibular parameters 1. Cumulative mesiodistal crown width (TTM) 2. Intercanine width 3. First interpremolar width 4. First intermolar width 5. Arch length 6. Arch perimeter 80.03 + 3.44 81.98 + 2.68 80.60 + 4.54 0.265 0.325 1.000 1.000 25.7 + 1.71 34.70 + 1.94 43.77 + 2.14 32.6 + 2.40 57.47 + 3.22 25.7 + 1.67 34.6 + 1.23 42.97 + 1.88 32.67 + 1.99 57.17 + 2.05 25.2 + 2.00 34.05 + 2.06 41.75 + 1.34 31.50 + 2.92 55.55 + 1.73 0.600 0.625 0.030* 0.402 0.046* 1.000 1.000 0.664 1.000 1.000 1.000 1.000 0.027* 0.637 0.047* 1.000 1.000 0.376 0.719 0.154 Other parameters 1. Overjet 2. Overbite 3. Palatal height 4. Curve of Spee 2.70 + 1.17 3.48 + 0.94 20.05 + 2.24 1.85 + 0.80 1.93 + 0.70 2.47 + 1.30 21.73 + 2.81 2.0 + 0.82 2.55 + 1.21 2.10 + 1.13 23.05 + 3.00 3.15 + 0.80 0.103 0.004** 0.0143* 0.001*** 0.116 0.033* 0.201 1.000 1.000 0.008** 0.015* 0.000*** 0.474 1.000 0.675 0.003** p-value: > 0.05 nonsignificant; *: <0.05 just significant; **: <0.01 moderately significant; ***: <0.001 highly significant height and curve of Spee increased from hypodivergent to hyperdivergent (see Tables 2 and 3). Table 4 (Figs 7A to C) shows that dental arch dimension measurements of male and female subjects. It was clearly demonstrated that males had larger arch dimensions than females. DISCUSSION The facial growth pattern differs from individual to individual and the variations in the dentofacial patterns are quite high. The assessment of relationship of dental arch dimensions with the vertical dentofacial pattern is essential to understand the The Journal of Indian Orthodontic Society, October-December 2012;46(4):316-324 319 Amit Kumar Khera et al Figs 5A to C: Comparison of variables in different subgroups (Ia, Ib,Ic) of Group I (male) variation in size and shape of dental arches. Research has established the importance of vertical dimension. It has been suggested that a subject with a high MP-SN angle tends to have a longer face and narrower arch dimensions and one with a low MP-SN angle often has a shorter face and wider arch dimensions (Ricketts et al 19824, Enlow and Hans 19967). A well-established sexual dimorphism in the arch dimensions has been found to exist in the vertical plane [Wei (1970),8 Christie (1977), 9 Eroz et al (2000) 10 and Forster et al (2008)11]. They found that males had sufficiently larger arch widths as compared with females. Therefore, the subjects were 320 segregated according to sex to maintain the homogeneity of the sample. Jarabak and Siriwat (1985),5 Bishara and Jakobsen (1985)12 had also found a sexual dimorphism to exist among various facial types. In the present study, subjects were divided into subgroups: Hypodivergent, normodivergent and hyperdivergent on the basis of Jarabak ratio (Table 1) because it is a reliable measurement, constructed from anatomic landmarks (Bishara and Jakobsen, 198512) and the chance of human error is also minimized by using a ratio instead of linear parameter. Only skeletal Class I subjects were selected because considerable JAYPEE JIOS Relationship between Dental Arch Dimensions and Vertical Facial Morphology in Class I Subjects Table 4: Comparison of arch dimension between Group I (male) and Group II (female) Parameters (in mm) Group I (n = 45) Group II (n = 45) Mean ± SD Mean ± SD p-value Maxillary parameters 1. Cumulative mesiodistal crown width (TTM) 2. Intercanine width 3. First interpremolar width 4. First intermolar width 5. Arch length 6. Arch perimeter 90.11 + 3.62 36.08 + 2.31 43.26 + 2.72 48.31 + 2.24 36.83 + 2.16 64.31 + 2.66 88.50 + 3.07 34.41 + 1.75 42.00 + 2.60 45.97 + 2.75 36.23 + 2.84 62.28 + 2.96 0.086 0.001** 0.030* 0.001** 0.272 0.001** Mandibular parameters 1. Cumulative mesiodistal crown width (TTM) 2. Intercanine width 3. First interpremolar width 4. First intermolar width 5. Arch length 6. Arch perimeter 82.67 + 3.69 26.87 + 1.83 35.18 + 2.22 44.69 + 2.23 32.51 + 2.19 58.32 + 2.55 80.80 + 3.52 25.95 + 1.74 34.32 + 1.74 42.92 + 2.22 32.41 + 2.39 57.11 + 2.69 0.017* 0.067 0.047* 0.004** 0.838 0.034* Other parameters 1. Overjet 2. Overbite 3. Palatal height 4. Curve of Spee 2.11 + 0.95 2.17 + 0.97 23.02 + 2.85 2.06 + 0.59 2.41 + 1.00 3.06 + 1.17 20.69 + 2.67 2.14 + 0.77 0.199 0.001** 0.001** 0.567 p-value: NS > 0.05 nonsignificant; *: <0.05 just significant; **: <0.01 moderately significant natural dentoalveolar compensation is expected in skeletal Class II or Class III subjects, which might obscure the relationship between vertical facial morphology and arch dimensions. When intragroup comparisons were done between hypodivergent, normodivergent and hyperdivergent subgroups of both male and female groups (see Tables 2 and 3), the mean value of cumulative mesiodistal crown width did not show any statistically significant difference (p > 0.05) suggesting that the tooth size appear to be a variable independent of the vertical growth pattern. This finding was also supported by studies done by Nasby et al (1972).13 For maxillary arch, there was a statistically significant inverse relationship between vertical facial morphology and dental arch width at maxillary canine, first premolar and first molar region in males and only between first molar widths in females. For mandibular arch, it was found that males had statistically significant correlation between vertical facial morphology and mandibular intercanine, first interpremolar and first intermolar widths but, in females, only first intermolar width was significant. These findings were supported by Nasby et al (1972),13 while they were in contrast to Eroz et al (2000)9 and Forster et al (2008)10 who demonstrate that mandibular first intermolar width was similar in hypodivergent and hyperdivergent subjects, however, the present data did not support such a relationship. In the present study, it was also observed that males had larger maxillary and mandibular first intermolar width than females. Similar findings have also been reported by the Eroz et al (2000)9 and Foster et al (2008).10 Isaacson et al (1971)14 reported that steep mandibular plane individuals generally had narrower maxillary first intermolar width than flat mandibular plane individuals. They suggested that the backward rotation of mandible in high MP-SN cases cause an increase in facial height which tends to lengthen the musculature. As the muscles are elongated, the passive stretch tension increases, which in turn causes the maxillary arch to be constricted. Conversely, the low MP-SN growth pattern has less facial height tending to permit maxillary teeth to move toward buccoversion. Nasby et al (1972)13 also reported that backward rotating mandible (hyperdivergent pattern) were associated with narrower intermolar widths. Musculature has been considered as a possible link in this close relationship between the transverse dimension and vertical facial morphology. The present study also suggests that maxillary and mandibular arch lengths are similar in hypodivergent, normodivergent and hyperdivergent subgroups, whereas the arch perimeter was greater in hypodivergent than hyperdivergent sujects. Similar findings were reported by Nasby et al (1972).13 No significant difference was found for overjet in hypodivergent, normodivergent and hyperdivergent subgroups for both the sexes, but overbite was found to decrease with increase in vertical dimension. So, the overbite was more in hypodivergent and less in hyperdivergent subjects for both the groups. Nasby et al (1972)13 also reported that hyperdivergent subjects were associated with longer anterior and posterior alveolar heights that will result the dental open bite or reduced overbite in these subjects. Palate was found to be high in hyperdivergent subgroup and shallow in hypodivergent subgroup for both males and females. Curve of Spee was found to increase as the facial height increased. These findings suggest that the depth of curve of Spee was more in hyperdivergent as compare with hypodivergent male and female subjects, because of decrease in arch perimeter in hyperdivergent group, there may be compensatory increase in curve of Spee to accommodate the tooth material. Schudy (1968)15 explained the importance of dentoalveolar dimension to establish the overbite. According to him, mandibular incisors are the best compensator in preventing the open bite. The Journal of Indian Orthodontic Society, October-December 2012;46(4):316-324 321 Amit Kumar Khera et al Figs 6A to C: Comparison of variables in different subgroups (IIa, IIb, IIc) of Group II (female) Another possible explanation for the increased curve of Spee in hyperdivergent subjects was that, because of vertical skeletal dysplasias, the natural dentoalveolar compensation in mandibular anterior region will take place to establish normal overbite (Anwar et al 2009).16 A possible explanation to our findings regarding the different influence of the vertical facial pattern on arch dimensions for both the sexes can be attributed to the different impact of genetic factors on males and females. A genetic study of cephalometric variables performed in twins showed that the genetic determination for vertical variables was 77.3% for boys and 72.8% for girls (Carels C 2001).17 This could 322 explain the gender differences found in our study, in the sense that females have a weaker genetic determination than males for the vertical craniofacial morphology. The results of present study provide normative data for the arch dimensions of hypodivergent, normodivergent and hyperdivergent male and female subjects. The study also provides a comparative evaluation of arch dimension in different vertical-facial pattern which is an important adjunct for selection of treatment plan. Many authors have acknowledged that there is variability in size and shape of human archforms. People from different ethnic groups present with different physiologic conditions, JAYPEE JIOS Relationship between Dental Arch Dimensions and Vertical Facial Morphology in Class I Subjects Figs 7A to C: Comparison of variables in male and female groups and clinician should anticipate the difference in size and form rather than treating all cases to a single ideal. Little, 18 based on more than 35 years of research, recommended as a clinical guideline that patient’s pretreatment archform be used as a guide to posttreatment archshape. The limitations of present study must be acknowledged because of the large individual variation encountered and dental arch dimensions are certainly a multifactorial phenomenon (Schulhof et al, 1978). 19 The general consensus is that individuals with strong or thick mandibular elevator muscles tend to exhibit wider transverse head dimensions (Hannam and Wood, 1989,20 Kiliaridis and Kalebo 199121). This study can be made more exhaustive by observing the effect of the muscle activity (using ultrasonography) on arch dimensions in different dentofacial patterns. CONCLUSION Following conclusions were drawn from present study: 1. Maxillary and mandibular first intermolar width, arch perimeter and maxillary first interpremolar width were The Journal of Indian Orthodontic Society, October-December 2012;46(4):316-324 323 Amit Kumar Khera et al 2. 3. 4. 5. 6. 7. maximum in hypodivergent followed by normodivergent and minimum in hyperdivergent in males as well as in females. Maxillary intercanine width, mandibular intercanine width and first interpremolar width were higher in the hypodivergent as compared with hyperdivergent in males. The overbite had a negative correlation with vertical facial height for both the sexes. This concludes that overbite was more in hypodivergent as compared with hyperdivergent subjects. The palate height was more in hyperdivergent and shallow in hypodivergent in males as well as in females. Curve of Spee was high in hyperdivergent as compared with hypodivergent in males as well as in females. Maxillary and mandibular first interpremolar width, first intermolar width and arch perimeter were greater in males as compared with females. Maxillary intercanine width and palatal height were more in males as compared with females, while overbite was more in females. REFERENCES 1. Penrose LS. Distance, size and shape. Annals of Eugenics 1954;18:337. 2. Schudy FF. Vertical growth versus anteroposterior growth as related to function and treatment. Angle Orthod 1964;34:75-93. 3. Opdebeeck H, Bell WH. The short face syndrome. Am J Orthod 1978;73:499-511. 4. Ricketts RM, Roth RH, Chaconas SJ, Schulhof RJ, Engel GA. Orthodontic diagnosis and planning. Rocky Mountain Data Systems, Denver 1982. 5. Siriwat PP, Jarabak JR. Malocclusion and facial morphology is there a relationship? 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Kiliaridis S, Kalebo P. Masseter muscle thickness measured by ultrasonography and its relation to facial morphology. J Dent Res 1991;70:1262-65. JAYPEE