Download Cephalometric features for maxillary incisors sagital position

Cephalometric Features for Maxillary Incisors Sagital position
CEPHALOMETRIC FEATURES FOR MAXILLARY INCISORS
SAGITAL POSITION / INCLINATION IN CLASS II DIV 1
1
SAAD ASAD, FCPS (Orthodontics), Invisalign Certified Orthodontist
2
SAQIB NAEEM, FCPS (Orthodontics)
3
FAYYAZ AHMAD, FCPS (Orthodontics), M Orth RCSed (Edin)
ABSTRACT
One of the chief concerns of patients reporting for orthodontic treatment is unacceptable Maxillary
Incisor position in sagital plane on underlying Skeletal Class II1,2. The purpose of the this study was
to find cephalometric features for Maxillary Incisor Sagital Position / Inclination in Class II div 1 cases
on Skeletal Class II basis and to establish correlation among various parameters used to assess the
Maxillary Incisor Sagital Position / Inclination. Study was conducted on 50 patients and following
conclusions were drawn: 1) Statistically significant increased Maxillary Incisor sagital inclination
and position as assessed by <UI-SN, <UI-PP, UI-NA (deg) and UI-NA (dist.) and as confirmed by
statistically significant co-relation between above mentioned parameters and parameters used to assess
skeletal class II (ANB, Wits) and 2) Statistically significant co-relation exists among various parameters
used to assess Maxillary Incisor inclination & position i.e.<UI-SN, <UI-PP, UI-NA (deg) and UI-NA
(dist.)
Key words: Maxillary Incisors Sagital Position / Inclination, <UI-SN, <UI-PP, UI-NA (deg) and
UI-NA
INTRODUCTION
One of the chief concerns of patients reporting for
orthodontic treatment is unacceptable / abnormal Maxillary Incisor position in sagital plane. Planned Maxillary Incisor Position (PIP) is thus one of the requirements to achieve ideal orthodontic results.3 Most of the
patient whose chief concern is unacceptable Maxillary
Incisor Position / Inclination have Class II div 1 incisor
relationship. Different cephalometric and non-cephalometric methods have been used to assess the maxillary
Incisor Sagital Position / inclination in literature4-10
however among cephalometric methods few widely
used are i.e. Upper Incisor to SN Plane angle (UI-SN
Plane angle), Upper Incisor to Palatal Plane angle (UIPP angle), Upper Incisor to NA line (UI-NA deg) and
Upper Incisor to NA line distance (UI-NA).11,12
The purpose of the present study was to find
cephalometric features for Maxillary Incisor Sagital
Position / Inclination in Class II div 1 cases on Skeletal
Class II basis using above mentioned angular and linear
measurement and to establish correlation among various parameters used to assess the Maxillary Incisor
Sagital Position / Inclination.
METHODOLOGY
The study was conducted on patients who reported
at Faculty of Dentistry, The University of Lahore with
the chief concern that their upper incisors are not at
proper position. From this study group subjects with
convex profile and Overjet> 4mm having age range of
14-25 years were selected while subjects having supernumerary or congenitally missing teeth, already undergoing with orthodontic treatment and Syndromes,
were excluded. Sample was collected using the nonprobability convenience sampling technique.
Photographs, Study Casts & Lateral Cephalogram
were taken for each subject. Lateral Cephalogram was
then traced and sagital pattern of the patient was
Correspondence: 1Dr Saad Asad, Assistant Professor, Department of Orthodontics, The Faculty of Dentistry,
The University of Lahore. E-mail: [email protected]
Associate Professor, Head of Department of Orthodontics, University College of Dentistry, The University of
Lahore
3
Assistant Professor, Department of Orthodontics, Institute of Dentistry, CMH Medical College, Lahore
2
Pakistan Oral & Dental Journal Vol 30, No. 2 (December 2010)
402
Cephalometric Features for Maxillary Incisors Sagital position
established from ANB angle (ANB>40)13,14 and or wits
value (1.5 mm). 15 50 patients (25 males & 25 females)
fulfilling the selection criteria were included in the
study. Maxillary Incisor Sagital Position / Inclination
for the selected sample was assessed by Upper Incisor
to SN Plane angle (UI-SN Plane angle; norm 1020+5),
Upper Incisor to Palatal Plane angle (UI-PP angle;
norm 1080+5), and Upper Incisor to NA line (UI-NA
(deg); norm 40+1.5) and Upper Incisor to NA line (UINA (dis); norm 25mm)
STATISTICAL METHOD
SPSS 16.0 was used for statistical evaluation.
1
Mean, Standard Deviation, Variance, Minimum &
Maximum value and Range were calculated for
each variable for each subject.
2
Correlation coefficients(r) between the various
methods used to assess Maxillary Incisor Sagital
Position / Inclination was calculated using Pearson’s
correlation.
RESULTS
The study was conducted on 50 subjects (25 females and 25 males) with mean age 17.92+4.20.
Descriptive Statistics were calculated for each variable
for each subject as shown in Table 1. All parameters
used to assess Maxillary Incisor Sagital Position /
Inclination are increased in Class II div1 cases on
Skeletal Class II basis i.e. <UI-SN (1020 +5) is
110.220+8.64, <UI-PP (1080+5) is 118.660+6.99, UI-NA
deg (40+1.5) is 5.860+3.55 and UI-NA dis. (25 mm) is
27.950+8.74
Fig 1: Class II Malocclusion Treatment
Pakistan Oral & Dental Journal Vol 30, No. 2 (December 2010)
403
Cephalometric Features for Maxillary Incisors Sagital position
TABLE 1: DESCRIPTIVE STATISTICS
N= 50
assess the Maxillary Incisor Sagital Position /Inclination as shown in the Table 3.
Minimum
Maximum
Mean
S.D
AGE
12.00
30.00
17.92
4.20
ANB
5.00
12.00
6.30
1.92
WITS
2
11.00
3.46
1.90
UI-SN
90.00
131.00
110.22
8.64
UI-PP
97.00
135.00
118.66
6.99
UI-NA (deg)
.00
20.00
5.86
3.55
UI-NA (dis)
8.00
53.00
27.95
8.74
TABLE 2: COMPARISON BETWEEN SKELETAL
CLASS II (ASSESSED BY ANB & WITS) AND
PARAMETERS USED TO ASSESS MAXILLARY
INCISOR SAGITAL POSITION / INCLINATION
Parameters
t-value
df
P-Value
ANB – UISN
-85.402
49
.000
ANB – UIPP
-112.694
49
.000
ANB & UI-NA (deg)
.806
49
.004
ANB & UI-NA (dis)
-17.368
49
.000
WITS – UISN
-88.071
49
.000
WITS & UI-NA (deg)
-4.285
49
.000
WITS – UIPP
-115.864
49
.000
WITS & UI-NA (dis)
-20.127
49
.000
Paired Samples Test
TABLE 3: PEARSON CORRELATIONS
UISN
UI-PP
UI-NA (deg)
UI-PP
UI-NA
(deg)
UI-NA
(dis.)
.874**
.669**
.774**
.609**
.789**
.778**
** Correlation is significant at the 0.01 level (2-tailed).
Statistically significant relationship was found between the Parameters used to assess Skeletal Class II
i.e. ANB angle & WITS Value and parameters used to
assess the Maxillary Incisor Sagital Position /Inclination as shown in the Table 2.
It is also worth mentioning that statistically significant co-relation exists between the parameters used to
DISCUSSION
Prevalence of Class II Malocclusions is just second to Class I Crowding. Treatment protocols and
clinical resources frequently employed in the management of class II malocclusion16,17 are as shown in
flowchart 1
Patients reporting for orthodontic treatment with
underlying Skeletal Class II Malocclusion usually have
a chief concern of prominent Maxillary Incisors. Proper
assessment of Maxillary Incisor Inclination / Position
in sagital plane18 is pivotal along with other assessments for treatment selection, which can be assessed
by various methods including lateral cephalometric
analysis. Various cephalometric methods have been
used to assess this. Aim of this study was thus to assess
the Maxillary Incisor Sagital Poistion / Inclination and
to determine its cephalometric features in Class II div
1 Incisor relationship on Skeletal Class II basis, This
would definitely help in correcting the incisor relationship more effectively.
In this study all parameters used to assess Maxillary Incisor Sagital Position /Inclination were increased
i.e. <UI-SN (1020+5) is 110.220+8.64, <UI-PP (1080+5) is
118.660+6.99, UI-NA deg (40+1.5) is 5.860+3.55 and UINA dis. (25 mm) is 27.950+8.74 as shown in Table I.
Thus in Class II div1 cases on Skeletal Class II basis
there is significant component of increased maxillary
incisors inclination and they are also positioned forward suggesting that treatment in such patients would
need change in incisor inclination and there position as
far as maxillary incisors are concerned. This also is
confirmed by Statistically significant relationship found
in this study between the Parameters used to assess
Skeletal Class II i.e. ANB angle and WITS Value and
parameters used to assess the Maxillary Incisor Sagital
Position /Inclination as shown in the Table 2.
It is also worth mentioning that statistically significant co-relation exists between different parameters
used to assess the Maxillary Incisor Sagital Position /
Inclination i.e. <UI-SN and <UI-PP (r= .874), <UI-SN
and UI-NA deg (r=.669), <UI-SN and UI-NA dis.(r=
.774), <UI-PP and <UI-NA deg (r=.609), <UI-PP and UINA dis. (r=.789) & between UI-NA deg and UI-NA dis.
(r=.778) as shown in the Table 3.
Pakistan Oral & Dental Journal Vol 30, No. 2 (December 2010)
404
Cephalometric Features for Maxillary Incisors Sagital position
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Pakistan Oral & Dental Journal Vol 30, No. 2 (December 2010)
405
CONCLUSION
Following conclusions can be drawn form this study:
Statistically significant increased Maxillary Incisor
sagital inclination and position as assessed by <UISN, <UI-PP, UI-NA (deg) and UI-NA (dist.) in Class
II div 1 on Skeletal Class II basis and as confirmed
by statistically significant co-relation between parameters used to assess skeletal class II (ANB,
Wits) and above mentioned parameters used to
assess Maxillary Incisor position
Statistically significant co-relation exists among
various parameters used to assess Maxillary Incisor position i.e.<UI-SN, <UI-PP, UI-NA (deg) and
UI-NA (dist.)
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